Idiopathic Toe Walking
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Top Contributors - Lauren Heydenrych, Jess Bell, Robin Tacchetti, Tarina van der Stockt and Kim Jackson
Introduction[edit | edit source]
Toe walking is a condition whereby the weight during gait is placed primarily on the forefoot or metatarsal heads[1]. Idiopathic toe walking (ITW) is a term used to describe a condition seen in ambulant children where this toe-toe pattern of walking is observed, without any known pathology. ITW is also known as habitual toe walking, toe walking, and congenital short tendo calcaneus[2].
An operationl definition given by Dilger [1] in the first page of thier report is “an equinus gait, initially without fixed contractures, with passive dorsiflexion range of motion (ROM) of the plantarflexor musculature to dorsiflex to at least neutral (0°) with the subtalar joint inverted and with the knee extended."
Aetiology[edit | edit source]
The aetiology remains unclear for ITW. When it was initially described in the 1960's a genetically inherited trait was attributed to its development.[1]Another, more recent school of thought is that ITW is a product of hyperreactivity of reflexes; an adaption to sensory feedback[3] It has been hypothesized that a delay in maturation of the corticospinal tract results in a lack of inhibition of the stretch reflexes and subsequent increased deep tendon reflexes. In regards to the feedforward mechanisms, dysregulation in the sensory integration system has been hypothesised. Sensory integration is "the registration and modulation of sensory input for the execution of motor output". [1](p4) Examples of disrupted regulation can be viewed with hypertonia, leading to decreased proprioceptive and vestibular input, and thus altered biomechanics, seeking further input through the metatarsal joints. On the opposite end of the spectrum, tactile defensiveness resulting from the input which is perceived as too much or noxious could also result in the toe walking gait.[1]
Pathophysiology[edit | edit source]
While the aeitiology of ITW remains unclear, there is consensus that as the child progresses in age, certain biomechanical changes occur. This includes shortened tendon achilles, as well as contractures of the foot and ankle joints.[4][1][2]
Epidemiology[edit | edit source]
Reports of the incidence of ITW vary considerably. From 7%-24% [5]to between 2% - 5%[2][3]This is seen in part because much of the literature views toe-walking as part of normal gait development in children under the age of 2 years[4]
Clinical Presentation[edit | edit source]
Differential Diagnosis[edit | edit source]
Diagnostic procedures[edit | edit source]
Prognosis[edit | edit source]
Management[edit | edit source]
Medical management[edit | edit source]
Conservative management[edit | edit source]
Physiotherapy management[edit | edit source]
Additional read[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Dilger N. Idiopathic Toe Walking: A diagnosis of Exclusion or a Developmental Marker. Los Angeles, California. Footprints Pediatric Physical Therapy. 2005
- ↑ 2.0 2.1 2.2 · Le Cras S, Bouck J, Brausch S, Taylor-Haas A. Evidence-based Clinical Care Guideline for Management of Idiopathic Toe Walking. Cincinnati Children's Hospital Medical Center. Guideline 040, pages 1-17 (2011).
- ↑ 3.0 3.1 Lorentzen J, Willerslev‐Olsen M, Hüche Larsen H, Svane C, Forman C, Frisk R, Farmer SF, Kersting U, Nielsen JB. Feedforward neural control of toe walking in humans. The Journal of physiology. 2018 Jun;596(11):2159-72.
- ↑ 4.0 4.1 Van Kuijk AA, Kosters R, Vugts M, Geurts AC. Treatment for idiopathic toe walking: a systematic review of the literature. Journal of rehabilitation medicine. 2014 Nov 1;46(10):945-57.
- ↑ Sobel E, Caselli MA, Velez Z. Effect of persistent toe walking on ankle equinus. Analysis of 60 idiopathic toe walkers. Journal of the American Podiatric Medical Association. 1997 Jan;87(1):17-22.
