Idiopathic Toe Walking: An Update on Natural History, Diagnosis, and Treatment

Abstract

Toe walking is a common presenting report to an orthopaedic practice. Evaluation of a child with toe walking includes a thorough history and physical examination to elucidate the diagnosis. When no other diagnosis is suspected, a diagnosis of idiopathic toe walking is often given. Despite the high prevalence of the condition, there is notable controversy of the nomenclature of the disease. Recent research has shed more light on both the natural history and the genetic basis. The use of motion analysis, including EMG and multisegment foot model, may help both differentiate children with mild forms of cerebral palsy and evaluate outcomes after treatment. Early treatment for young children with adequate range of motion (ROM) is generally reassurance because most young children with idiopathic toe walking are expected to resolve spontaneously. When the toe walking persists, treatment options include both surgical and nonsurgical management. Nonsurgical management centers on obtaining ROM through stretching and serial casting, followed by gait retraining and bracing treatment. Surgical lengthening at either the Achilles or gastrocnemius level improves the ROM of the ankle and then similarly requires therapy and bracing treatment to obtain a more normalized gait.

Idiopathic Toe Walking: What’s New? An Integrative Review

“…Finally, the lack of consensus in results is apparent due to the heterogeneity in methodologies, as discussed by [40] in their systematic review of outcomes and assessment tools, as well as in Bauer's (2022) [30] and Williams' (2020) [52] findings, which identified a lack of consensus among healthcare professionals regarding evidence-based therapies. Heterogeneity is seen in populations across studies [32,37,45], the type of severity classification used [29,32,42], previous treatments [46,47], and different exclusion criteria [19,42], among other differences, making results comparison unfeasible.…”

“…Bauer et al (2022) [30] introduced a descriptive classification for children who walk on their toes. In a straightforward manner, they divided it into toe walking during developmental stages, ITW with autism, congenital tendon contracture, habitual persistent ITW (without contracture), and finally, persistent ITW with contracture (Figure 3).…”

“…Idiopathic Toe Walking: An Update on Natural History, Diagnosis, and Treatment.Journal of the American Academy of Orthopaedic Surgeons, 30(22), e1419-e1430. )[30].…”

Children’s orthopaedics

“…This review paper from Portland (Oregon, USA) is a recommended read for interested surgeons as it thoroughly discusses the current treatment and literature surrounding idiopathic toe walking. 4 Gait motion analysis and multisegment foot modelling are recommended to differentiate mild forms of cerebral palsy and to evaluate treatment outcomes; centres without access to these modalities would be wise to generate these with neighbouring centres in order to offer the best decision-making for patients. The review concluded that early treatment should appropriately be reassurance only, as the majority will resolve spontaneously and the prevalence of the condition is relatively high.…”

Gut Microbiome Dysbiosis as a Potential Risk Factor for Idiopathic Toe-Walking in Children: A Review

“…Although ITW has been known for more than half a century, we still do not know much about its etiology [14,15]. Currently, there is a growing interest in the diagnosis, treatment, classification, and causes of ITW.…”