Abstract
Idiopathic toe-walking (ITW) describes a condition in which children walk with a toe-to-toe gait pattern in the absence of any known cause (Sala et al., Dev Med Child Neurol 41:846–8, 1999). Although it is occasionally exhibited by young, typically developing children, ITW is more common among children with intellectual disabilities. Over time, ITW causes ankle, joint, and tendon problems and can result in long-term ambulation difficulties. In this chapter, we describe the prevalence and assessment of ITW, as well as medical and behavioral interventions for ITW. We conclude with some recommendations for future research.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Accardo, P. J., & Barrow, W. (2015). Toe walking in autism: Further observations. Journal of Child Neurology, 30(5), 606–609. https://doi.org/10.1177/0883073814521298
Accardo, P., Morrow, J., Heaney, S., Whitman, B., & Tomazic, T. (1992). Toe walking and language development. Clinical Pediatrics, 31(3), 158–160. https://doi.org/10.1177/000992289203100306
Alvarez, C., De Vera, M., Beauchamp, R., Ward, V., & Black, A. (2007). Classification of idiopathic toe walking based on gait analysis: Development and application of the ITW severity classification. Gait & Posture, 26(3), 428–435. https://doi.org/10.1016/j.gaitpost.2006.10.011
Anwar, M. S., & Zafar, H. (2013). Efficacy of botulinum toxin in benign essential Blepharospasm: Desirable & undesirable effects. Pakistan Journal of Medical Sciences, 29(6), 1389–1393. https://doi.org/10.12669/pjms.296.3853
Barrett, R. P., & Linn, D. M. (1981). Treatment of stereotyped toe-walking with overcorrection and physical therapy. Applied Research in Mental Retardation, 2(1), 13–21. https://doi.org/10.1016/0270-3092(81)90003-5
Barrow, W. J., Jaworski, M., & Accardo, P. J. (2011). Persistent toe walking in autism. Journal of Child Neurology, 26(5), 619–621. https://doi.org/10.1177/0883073810385344
Bishop, C. (2016). Evaluation of pediatric toe walking. Physician Assistant Clinics, 1(4), 599–613. https://doi.org/10.1016/j.cpha.2016.05.00
Brouwer, B., Davidson, L. K., & Olney, S. J. (2000). Serial casting in idiopathic toe-walkers and children with spastic cerebral palsy. Journal of Pediatric Orthopedics, 20(2), 221–225.
Caselli, M. A. (2002). Habitual toe walking toe walking: Learn to evaluate and treat this idiopathic childhood condition. Podiatry Management, 21(9), 163–174.
Caserta, A. J., Pacey, V., Fahey, M. C., Gray, K., Engelbert, R. H., & Williams, C. M. (2019). Interventions for idiopathic toe walking. The Cochrane Database Systematic Reviews, 10, CD012363. https://doi.org/10.1002/14651858.CD012363.pub2
Charlop, M. H., Burgio, L. D., Iwata, B. A., & Ivancic, M. T. (1988). Stimulus variation as a means of enhancing punishment effects. Journal of Applied Behavior Analysis, 21(1), 89–95. https://doi.org/10.1901/jaba.1988.21-89
Davies, K., Black, A., Hunt, M., & Holsti, L. (2018). Long-term gait outcomes following conservative management of idiopathic toe walking. Gait & Posture, 62, 214–219. https://doi.org/10.1016/j.gaitpost.2018.02.014
Durand, V. M., & Crimmins, D. B. (1992). The Motivation Assessment Scale (MAS) administration guide. Monaco and Associates.
Eastwood, D. M., Menelaus, M. B., Dickens, D. R., Broughton, N. S., & Cole, W. G. (2000). Idiopathic toe-walking: Does treatment alter the natural history? Journal of Pediatric Orthopedics, 9(1), 47–49. https://doi.org/10.1097/01202412-200001000-00010
Engström, P., & Tedroff, K. (2012). The prevalence and course of idiopathic toe-walking in 5-year-old children. Pediatrics, 130(2), 279–284. https://doi.org/10.1542/peds.2012-0225
Engström, P., & Tedroff, K. (2018). Idiopathic toe-walking: Prevalence and natural history from birth to ten years of age. The Journal of Bone and Joint Surgery, 100(8), 640–647. https://doi.org/10.2106/JBJS.17.00851
Engström, P., Gutierrez-Farewik, E. M., Bartonek, Å., Tedroff, K., Orefelt, C., & Haglund-Åkerlind, Y. (2010). Does botulinum toxin A improve the walking pattern in children with idiopathic toe-walking? Journal of Children’s Orthopaedics, 4(4), 301–308. https://doi.org/10.1007/s11832-010-0263-9
Engström, P., Bartonek, Å., Tedroff, K., Orefelt, C., Haglund-Åkerlind, Y., & Gutierrez-Farewik, E. M. (2013). Botulinum toxin A does not improve the results of cast treatment for idiopathic toe-walking: A randomized controlled trial. Journal of Bone and Joint Surgery, 95(5), 400–407. https://doi.org/10.2106/JBJS.L.00889
Fanchiang, H. D., Geil, M. D., Wu, J., Ajisafe, T., & Chen, Y. P. (2016). The effects of walking surface on the gait pattern of children with idiopathic toe walking. Journal of Child Neurology, 31(7), 858–863. https://doi.org/10.1177/0883073815624760
Fox, A., Deakin, S., Pettigrew, G., & Paton, R. (2006). Serial casting in the treatment of idiopathic toe-walkers and review of the literature. Acta Orthopaedica Belgica, 72(6), 722.
Hall, J. E., Salter, R. B., & Bhalla, S. K. (1967). Congenital short tendo calcaneus. The Bone and Joint Journal, 49-B(4), 695–697.
Hastings‐Ison, T., Blackburn, C., Rawicki, B., Fahey, M., Simpson, P., Baker, R., & Graham, K. (2016). Injection frequency of botulinum toxin A for spastic equinus: a randomized clinical trial. Developmental Medicine & Child Neurology, 58(7), 750–757.
Hayes, K. B., Wimberly, R. L., VanPelt, J. M., Jo, C., Riccio, A., & Delgado, M. R. (2018). Toe walking: A neurological perspective after referral from pediatric orthopaedic surgeons. Journal of Pediatric Orthopedics, 38(3), 152–156. https://doi.org/10.1097/BPO.0000000000001115
Hemo, Y., Macdessi, S. J., Pierce, R. A., Aiona, M. D., & Sussman, M. D. (2006). Outcome of patients after Achilles tendon lengthening for treatment of idiopathic toe walking. Journal of Pediatric Orthopedics, 26(3), 336–340. https://doi.org/10.1097/01.bpo.0000217743.44609.44
Hirst, E. S., Lockenour, F. M., & Allen, J. L (2019). Decreasing toe walking with differential reinforcement of other behavior, verbal rules, and feedback. Education and Treatment of Children, 42(2):185–199. https://doi.org/10.1353/etc.2019.0009
Herrin, K., & Geil, M. (2016). A comparison of orthoses in the treatment of idiopathic toe walking: A randomized controlled trial. Prosthetics and Orthotics International, 40(2), 262–269. https://doi.org/10.1177/0309364614564023
Hicks, R., Durinick, N., & Gage, J. R. (1988). Differentiation of idiopathic toe-walking and cerebral palsy. Journal of pediatric orthopedics, 8(2), 160–163.
Hobbs, S. A., Altman, K., & Haldin, M. A. (1980). Modification of a child’s deviant walking pattern: An alternative to surgery. Journal of Behavior Therapy and Experimental Psychiatry, 11(3), 227–229. https://doi.org/10.1016/0005-7916(80)90033-6
Hodges, A., Wilder, D. A., & Ertel, H. (2018). The use of a multiple schedule to decrease toe walking in a child with autism. Behavioral Interventions, 33(4), 440–447. https://doi.org/10.1002/bin.1528
Hodges, A., Betz, A., Wilder, D., & Anita, K. (2019). The use of acoustical guidance to decrease toe walking in a child with autism. Education and Treatment of Children, 42, 151–160.
Iwata, B. A., Dorsey, M. F., Slifer, K. J., Baumna, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2(1), 3–20. https://doi.org/10.1016/0270-4684(82)90003-9
Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27(2), 197–209. https://doi.org/10.1901/jaba.1994.27-197
Iwata, B. A., DeLeon, I. G., & Roscoe, E. M. (2013). Reliability and validity of the functional analysis screening tool. Journal of Applied Behavior Analysis, 46(1), 271–284. https://doi.org/10.1002/jaba.31
Jacks, L. K., Michels, D. M., Smith, B. P., Koman, L. A., & Shilt, J. (2004). Clinical usefulness of botulinum toxin in the lower extremity. Foot and Ankle Clinics, 9, 339–348. https://doi.org/10.1016/j.fcl.2004.01.003
Jahn, J., Vasavada, A. N., & McMulkin, M. L. (2009). Calf muscle-tendon lengths before and after Tendo-Achilles lengthenings and gastrocnemius lengthenings for equinus in cerebral palsy and idiopathic toe walking. Gait & Posture, 29(4), 612–617.
Jowett, E. S., Lockenour, F. M., & Allen, J. L. (2019). Decreasing toe walking with differential reinforcement of other behavior, verbal rules, and feedback. Education and Treatment of Children, 42(2), 185–199. https://doi.org/10.1353/etc.2019.0009
Katz, M. M., & Mubarak, S. J. (1984). Hereditary tendo achillis contractures. Journal of Pediatric Orthopedics, 4(6), 711–714. https://doi.org/10.1097/01241398-198411000-00011
Kim, S., Soangra, R., Grant-Beuttler, M., & Aminian, A. (2019). Wearable sensor-based gait classification in idiopathic toe walking adolescents. Biomedical Sciences Instrumentation, 55(2), 178.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., La Martire, M. L., Oliva, D., & Groeneweg, J. (2012). Technology-based, pro-grams to promote walking fluency or improve foot-ground contact during walking: Two case studies of adults with multiple disabilities. Research in Developmental Disabilities, 33, 111–118. https://doi.org/10.1016/j.ridd.2011.08.029
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Alberti, G., Boccasini, A., Oliva, D., & Buono, S. (2013). Technology-based programs to improve walking behavior of persons with multiple disabilities: Two single-case studies. Disability and Rehabilitation: Assistive Technology, 8, 92–98. https://doi.org/10.3109/17483107.2012.678030
Lang, R., Rispoli, M., Sigafoos, J., Lancioni, G., Andrews, A., & Ortega, L. (2011). Effects of language of instruction on response accuracy and challenging behavior in a child with autism. Journal of Behavioral Education, 20(4), 252–259.
Leyden, J., Fung, L., & Frick, S. (2019). Autism and toe-walking: Are they related? Trends and treatment patterns between 2005 and 2016. Journal of Children’s Orthopaedics, 13(4), 340–345. https://doi.org/10.1302/1863-2548.13.180160
Marcus, A., Sinnott, B., Bradley, S., & Grey, I. (2010). Treatment of idiopathic toe-walking in children with autism using GaitSpot auditory speakers and simplified habit reversal. Research in Autism Spectrum Disorders, 4(2), 260–267. https://doi.org/10.1016/j.rasd.2009.09.012
Matthew, O., & Sean, P. (2012). Idiopathic toe walking. Journal of the American Academy of Orthopaedic Surgeons, 20, 292–300. https://doi.org/10.5435/JAAOS-20-05-292
McMulkin, M. L., Baird, G. O., Caskey, P. M., & Ferguson, R. L. (2006). Comprehensive outcomes of surgically treated idiopathic toe walkers. Journal of Pediatric Orthopaedics, 26(5), 606–611. https://doi.org/10.1097/01.bpo.0000230334.80910.0c
Michalitsis, J., Murphy, A. T., Rawicki, B., Haines, T. P., & Williams, C. (2019). Full length foot orthoses have an immediate treatment effect and modify gait of children with idiopathic toe walking. Gait & Posture, 68, 227–231. https://doi.org/10.1016/j.gaitpost.2018.11.022.
Ming, X., Brimacombe, M., & Wagner, G. C. (2007). Prevalence of motor impairment in autism spectrum disorders. Brain and Development, 29, 565–570. https://doi.org/10.1016/j.braindev.2007.03.002
Multani, I., Manji, J., Hastings-Ison, T., Khot, A., & Graham, K. (2019). Botulinum toxin in the management of children with cerebral palsy. Pediatric Drugs, 21(4), 261–281.
Paclawsky, T. R., Matson, J. L., Rush, K. S., Smalls, Y., & Vollmer, T. R. (2000). Questions about behavioral function (QABF): A behavioral checklist for functional assessment of aberrant behavior. Research in Developmental Disabilities, 21(3), 223–229. https://doi.org/10.1016/s0891-4222(00)00036-6
Persicke, A., Jackson, M., & Adams, A. N. (2014). Brief report: An evaluation of TAGteach components to decrease toe-walking in a 4-year-old child with autism. Journal of Autism and Developmental Disorders, 44, 965–968. https://doi.org/10.1007/s10803-013-1934-4
Pistilli, E., Rice, T., Pergami, P., & Mandich, M. B. (2014). Non-invasive serial casting to treat idiopathic toe walking in an 18-month-old child. NeuroRehabilitation, 34, 215–220.
Pomarino, D., Ramírez Llamas, J., Martin, S., & Pomarino, A. (2017). Literature review of idiopathic toe walking: Etiology, prevalence, classification, and treatment. Foot & Ankle Specialist, 10(4), 337–342. https://doi.org/10.1177/1938640016687370
Pollind, M., & Soangra, R. (2020). Development and validation of wearable inertial sensor system for postural sway analysis. Measurement, 165, 108101.
Querim, A. C., Iwata, B. A., Roscoe, E. M., Schlichenmeyer, K. J., Ortega, J. V., & Hurl, K. E. (2013). Functional analysis screening for problem behavior maintained by automatic reinforcement. Journal of Applied Behavior Analysis, 46, 47–60. https://doi.org/10.1002/jaba.26.
Ruzabarsky, J. J., Scher, D., & Dodwell, E. (2016). Toe walking: Causes, epidemiology, assessment, and treatment. Current Opinion in Pediatrics, 28(1), 40–46. https://doi.org/10.1097/MOP.0000000000000302
Sala, D. A., Shulman, L. H., Kennedy, R. F., Grant, A. D., & Chu, M. Y. (1999). Idiopathic toe-walking: A review. Developmental Medicine and Child Neurology, 41, 846–848. https://doi.org/10.1111/j.1469-8749.1999.tb00553.x
Sätilä, H., Beilmann, A., Olsén, P., Helander, H., Eskelinen, M., & Huhtala, H. (2016). Does botulinum toxin A treatment enhance the walking pattern in idiopathic toe-walking? Neuropediatrics, 47(03), 162–168. https://doi.org/10.1055/s-0036-1582138
Shulman, L. H., Sala, D. A., Chu, M. Y., McCaul, P. R., & Sandler, B. J. (1997). Developmental implications of idiopathic toe walking. The Journal of Pediatrics, 130, 541–546. https://doi.org/10.1016/s0022-3476(97)70236-1
Sobel, E., Casseli, M. A., & Velez, Z. (1997). Effect of persistent toe walking on ankle equinus. Journal of the American Podiatric Medical Association, 87, 17–22. https://doi.org/10.7547/87507315-87-1-17
Stott, N. S., Walt, S. E., Lobb, G. A., Reynolds, N., & Nicol, R. O. (2004). Treatment for idiopathic toe-walking: Results at skeletal maturity. Journal of Pediatric Orthopaedics, 24(1), 63–69.
Stricker, S. J., & Angulo, J. C. (1998). Idiopathic toe walking: A comparison of treatment methods. Journal of Pediatric Orthopedics, 18(3), 289–293.
Taussig, G., & Delouvee, E. (2001). Idiopathic toe walker child. Diagnosis and spontaneous evolution. In Annales de Readaptation et de Medecine Physique: Revue Scientifique de la Societe Francaise de Reeducation Fonctionnelle de Readaptation et de Medecine Physique 44(6), 333–339. https://doi.org/10.1016/s0168-6054(01)00110-6
Thielemann, F., Rockstroh, G., Mehrholz, J., & Druschel, C. (2019). Serial ankle casts for patients with idiopathic toe walking: Effects on functional gait parameters. Journal of Children’s Orthopaedics, 13(2), 147–154. https://doi.org/10.1302/1863-2548.13.180183
Valagussa, G., Trentin, L., Balatti, V., & Grossi, E. (2017). Assessment of presentation patterns clinical severity and sensorial mechanism of tip-toe behaviors in severe ASD subjects with intellectual disability. Autism Research, 10(9). 1547–1557. https://doi.org/10.1002/aur.17967
Van Bemmel, A. F., Van de Graaf, V. A., Van den Bekerom, M. P. J., & Vergroesen, D. A. (2014). Outcome after conservative and operative treatment of children with idiopathic toe walking: A systematic review of literature. Musculoskeletal Surgery, 98(2), 87–93. https://doi.org/10.1007/s12306-013-0309-5
Van Kuijk, A. A., Kosters, R., Vugts, M., & Geurts, A. C. (2014). Treatment for idiopathic toe walking: A systematic review of the literature. Journal of Rehabilitation Medicine, 46(10), 945–957. https://doi.org/10.2340/16501977-1881
Westberry, D. E., Davids, J. R., Davis, R. B., & de Morais Filho, M. C. (2008). Idiopathic toe walking: a kinematic and kinetic profile. Journal of Pediatric Orthopaedics, 28(3), 352–358.
Wilder, D. A., Ertel, H., Hodges, A. C., Thomas, R., & Luong, N. (2020). The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism. Journal of Applied Behavior Analysis, 53, 554–562. https://doi.org/10.1002/jaba.607
Williams, C. M., Tinley, P., & Curtin, M. (2010). Idiopathic toe walking and sensory processing dysfunction. Journal of Foot and Ankle Research, 3(1), 16.
Williams, C. M., Tinley, P. D., & Curtin, M. (2011). The “Toe Walking Tool”: A novel method of assessing toe walking children. Journal of Foot and Ankle Research, 4(Suppl 1), 1–1. https://doi.org/10.1186/1757-1146-4-S1-O51
Williams, C., Gray, K., Davies, N., Barkocy, M., Fahey, M., Simmonds, J., Accardo, P., Eastwood, D., & Pacey, V. (2020). Exploring health professionals’ understanding of evidence-based treatment for idiopathic toe walking. Child Care Health and Development, 46, 310–319. https://doi.org/10.1111/cch.12745
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Hodges, A.C., Wilder, D.A., Ertel, H. (2023). Assessment and Treatment of Toe Walking. In: Matson, J.L. (eds) Handbook of Applied Behavior Analysis. Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-031-19964-6_62
Download citation
DOI: https://doi.org/10.1007/978-3-031-19964-6_62
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-19963-9
Online ISBN: 978-3-031-19964-6
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)