Literature Review of Idiopathic Toe Walking: Etiology, Prevalence, Classification, and Treatment

Pomarino, David; Llamas, Juliana Ramírez; Martin, Stéphan; Pomarino, Andrea

doi:10.1177/1938640016687370

Cited by 13 publications

(13 citation statements)

References 29 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…; Pomarino et al . ). The causes of toe walking in children have not been clarified, but the belief that hyperactive reflexes are involved dominates current therapeutic strategies in the clinic (Tardieu et al .…”

Section: Introductionmentioning

confidence: 97%

Feedforward neural control of toe walking in humans

Lorentzen

Willerslev-Olsen

Larsen

et al. 2018

The Journal of Physiology

View full text Add to dashboard Cite

Toe walking requires careful control of the ankle muscles in order to absorb the impact of ground contact and maintain a stable position of the joint. The present study aimed to clarify the peripheral and central neural mechanisms involved. Fifteen healthy adults walked on a treadmill (3.0 km h ). Tibialis anterior (TA) and soleus (Sol) EMG, knee and ankle joint angles, and gastrocnemius-soleus muscle fascicle lengths were recorded. Peripheral and central contributions to the EMG activity were assessed by afferent blockade, H-reflex testing, transcranial magnetic brain stimulation (TMS) and sudden unloading of the planter flexor muscle-tendon complex. Sol EMG activity started prior to ground contact and remained high throughout stance. TA EMG activity, which is normally seen around ground contact during heel strike walking, was absent. Although stretch of the Achilles tendon-muscle complex was observed after ground contact, this was not associated with lengthening of the ankle plantar flexor muscle fascicles. Sol EMG around ground contact was not affected by ischaemic blockade of large-diameter sensory afferents, or the sudden removal of ground support shortly after toe contact. Soleus motor-evoked potentials elicited by TMS were facilitated immediately after ground contact, whereas Sol H-reflexes were not. These findings indicate that at the crucial time of ankle stabilization following ground contact, toe walking is governed by centrally mediated motor drive rather than sensory driven reflex mechanisms. These findings have implications for our understanding of the control of human gait during voluntary toe walking.

show abstract

Section: Introductionmentioning

confidence: 97%

Feedforward neural control of toe walking in humans

Lorentzen

Willerslev-Olsen

Larsen

et al. 2018

The Journal of Physiology

View full text Add to dashboard Cite

show abstract

“…Although adequate information of existing traditional interventions for toe-walking gait for functional neurological disorders is available in scientific reviews, there is no mention of the use of manual therapies specific to a "fluid model of human anatomy" [10,46,47]. There can be more than mere muscles and tendons that are tight and restricted created by a chronic posture.…”

Section: The Hypothesismentioning

confidence: 99%

“…On the other hand, known etiologies may be cerebral palsy or other neurological insult, a congenital contractures, or paralytic muscular disorders such as Duchenne Muscular Dystrophy [7][8][9]. Differential diagnosis is best reached through careful history and clinical exam of both neurological and orthopedic factors [4,10]. Toe-walking gait is a common behavioral feature extensively reported in children with Autism Spectrum Disorder (ASD), which often occurs with other neurological symptoms, including ataxia, hypotonia, variable stride length and duration, incoordination, postural abnormalities in the head and trunk, reduced plantarflexion and increased dorsiflexion [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Case Report: Lymphatic Drainage Resolves Toe Walking Gait in a Boy with Autism Spectrum Disorder

Vaughan¹

2020

Int J Foot Ankle

View full text Add to dashboard Cite

Objective: Describe how lymphatic drainage (LD) resolved obligatory toe walking gait and stance in a boy with Autism Spectrum Disorder (ASD). The treatment plan was generalized from an identical treatment given to a collegiate athlete with chronic spasms of gastronemii.Design: Review of medical record; photography evidence.Intervention: A single treatment of LD. No literature suggests a fluid anatomy model for manual therapies as treatment options for toe walking. This case highlights an effective method discovered to quickly reverse functional deformities despite several years of traditional pediatric interventions for toe walking in ASD.Results: Full weight bearing contact of bilateral plantar surfaces was gained in stance immediately. Active-assisted range of motion and progressive resistance training began to progress only after this breakthrough. Gains have since been made in gait and stance normalization, and foot kinetics. More invasive interventions (serial casting; reconstructive surgery) have been avoided. Gains sustained as evidenced in one year follow up. Conclusion:Emerging paradigm of lymphatic and interstitial anatomy provides novel treatment to change the functional status of muscle tissue and tone. Changes in passive and active ankle range of motion were a direct result of mobilizing and evacuating fluids of the gastrocnemii via lymphatic pathways. Spontaneous muscle softening and Achilles tendon lengthening happened instantly. An extremely light touch and pressure input from the therapist is required to perform lymphatic drainage. Lymphatic drainage massage holds promise for further use and study with issues such as toe walking gait and other orthopedic populations.

show abstract

“…17,18 Studies investigating the effectiveness of these treatment options are varied, with the natural history of sustained ITW remaining uncertain. 1,2,17,18,20,21 To our knowledge, current ITW treatment guidelines do not include specific recommendations for patients with comorbid conditions like ASD, and nonoperative treatments may be more challenging in patients with ASD if the patient has difficulty complying with instructions, sensitivity to tactile foot sensations/manipulation or is disturbed by the noise of cast saws. Medical treatment decisions should consider family preference, severity of the patient’s condition, as well as any comorbid conditions.…”

Section: Introductionmentioning

confidence: 99%

Autism and toe-walking: Are they related? Trends and treatment patterns between 2005 and 2016

Leyden

Fung

Frick

2019

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Purpose This study quantified toe-walking trends and treatment decisions in patients with autism spectrum disorder (ASD) in the United States between 2005 and 2016 using a large national private-payer database. Methods A retrospective database review was performed on paediatric patients with ASD, and for International Classification of Diseases-9/10 diagnosis codes for toe-walking. Patients were filtered based on treatment type by Current Procedural Terminology (CPT) code. Continued toe-walking rates were assessed for each patient population and treatment group. A Pearson’s chi-squared test was used to evaluate differences in group characteristics. Results Of 2 221 009 paediatric patients in the database, 5739 patients had a diagnosis of ASD, and 8.4% of patients with ASD also had a diagnosis of toe-walking (n = 484). For typically developing children in the database, 0.47% of patients had a diagnosis of persistent toe-walking. In all, 59.3% of ASD patients underwent physical therapy, 7.4% serial casting and 3.3% surgical correction, compared with 38.1%, 3.6% and 1.2% of normally developing children, respectively (chi-square 6.4031; p < 0.040699). Without intervention, 63.6% of patients with ASD continued to toe-walk within ten years of their diagnosis, with 19.3% of patients without ASD (chi-square 82.9762; p < 0.0001). Conclusion This study supports the association between a greater prevalence of toe-walking in children with ASD. We showed that patients with ASD and toe-walking receive surgical correction at nearly triple the rate of children without ASD who toe-walk. The continued rate of toe-walking is comparable between treatment groups as well as between ASD and typically developing children. Typically developing children have higher rates of toe-walking resolution without intervention than children with ASD. Level of evidence Level II

show abstract

Literature Review of Idiopathic Toe Walking: Etiology, Prevalence, Classification, and Treatment

Abstract: Level IV.

Cited by 13 publications

References 29 publications

Feedforward neural control of toe walking in humans

Feedforward neural control of toe walking in humans

Case Report: Lymphatic Drainage Resolves Toe Walking Gait in a Boy with Autism Spectrum Disorder

Autism and toe-walking: Are they related? Trends and treatment patterns between 2005 and 2016

Contact Info

Product

Resources

About