Skip to main content
SpringerLink
Log in

Idiopathic Toe Walking

  • Reference work entry
  • First Online:
Handbook of Human Motion

  • 708 Accesses

Abstract

Idiopathic toe walking in children is a diagnosis of exclusion. Toe walkers require investigation with a thorough clinical examination, observational gait assessment, and potential additional review to exclude an underlying diagnosis. Three-dimensional instrumented gait analysis is helpful to characterize the observed gait pattern and identify children that may benefit from intervention. It is most useful in the child with reduced range of motion at the ankle who has a toe-toe gait pattern but appears to have a heel strike on observational gait analysis. These children often compensate with either hyperextension of the knee in mid-stance, external foot progression, and/or an early heel rise, frequently missed with observational gait analysis. In this clinical scenario, instrumented three-dimensional gait analysis enables characterization of the toe walking pattern and identification of objective intervention outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Accardo P, Barrow W (2015) Toe walking in autism: further observations. J Child Neurol 30(5):606–609

    Article  Google Scholar 

  • Accardo P, Morrow J, Heaney M et al (1992) Toe walking and language development. Clin Pediatr (Phila) 31:158–160

    Article  Google Scholar 

  • Alvarez C, De Vera M, Beauchamp R et al (2007) Classification of idiopathic toe walking based on gait analysis: development and application of the ITW severity classification. Gait Posture 26:428–435

    Article  Google Scholar 

  • Alvarez C, De Vera M, Chhina H et al (2008) Normative data for the dynamic pedobarographic profiles of children. Gait Posture 28:309–315

    Article  Google Scholar 

  • Baker R (2013) Measuring walking: a handbook of clinical gait analysis. MacKeith Press, London

    Google Scholar 

  • Barrow W, Jaworski M, Accardo P (2011) Persistent toe walking in autism. J Child Neurol 26:619–621

    Article  Google Scholar 

  • Bovens A, van Baak M, Vrencken J et al (1990) Variability and reliability of joint measurements. Am J Sports Med 18(1):58–63

    Article  Google Scholar 

  • Bowen T, Miller F, Castagno P et al (1998) A method of dynamic foot-pressure measurement for the evaluation of pediatric orthopaedic foot deformities. J Pediatr Orthop 18(6):789–793

    Google Scholar 

  • Brunt D, Woo R, Kim H et al (2004) Effect of botulinum toxin type A on gait of children who are idiopathic toe-walkers. J Surg Orthop Adv 13(3):149–155

    Google Scholar 

  • Burnett C, Johnson E (1971) Development of gait in childhood II. Dev Med Child Neurol 13(2):207–215

    Article  Google Scholar 

  • Clark E, Sweeney J, Yocum A et al (2010) Effects of motor control intervention for children with idiopathic toe walking: a 5-case series. Pediatr Phys Ther 22:417–426

    Article  Google Scholar 

  • Crenna P, Redrizzi E, Andreucci E et al (2005) The heel-contact gait pattern of habitual toe walkers. Gait Posture 21(3):311–317

    Article  Google Scholar 

  • Cychosz C, Phisitkul P, Belatti D et al (2015) Gastrocnemius recession for foot and ankle conditions in adults: evidence-based recommendations. Foot Ankle Surg 21(2):77–85

    Article  Google Scholar 

  • DiGiovanni C, Kuo R, Tejwani N et al (2002) Isolated gastrocnemius tightness. J Bone Joint Surg 84(6):962–970

    Article  Google Scholar 

  • Eastwood D, Dennett X, Shield L et al (1997) Muscle abnormalities in idiopathic toe-walkers. J Pediatr Orthop Part B 6:215–218

    Article  Google Scholar 

  • Eastwood D, Memelaus M, Dickens D et al (2000) Idiopathic toe-walking: does treatment alter the natural history? J Pediatr Orthop 9:47–49

    Article  Google Scholar 

  • Engelbert R, Gorter J, Uiterwaal C et al (2011) Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness? BMC Musculoskelet Disord 12:61

    Article  Google Scholar 

  • Engström P, Tedroff K (2012) The prevalence and course of idiopathic toe-walking in 5-year-old children. Pediatrics 130(2):279–284

    Article  Google Scholar 

  • Engström P, Bartonek A, Tedroff K et al (2013) Botulinum toxin A does not improve the results of cast treatment for idiopathic toe-walking. A randomized controlled trial. J Bone Joint Surg Am 95:400–407

    Article  Google Scholar 

  • Fox A, Deakin S, Pettigrew G et al (2006) Serial casting in the treatment of idiopathic toe-walkers and review of the literature. Acta Orthop Belg 72:722–730

    Google Scholar 

  • Furrer F, Deonna T (1982) Persistent toe-walking in children: a comprehensive clinical study of 28 cases. Helv Paediatr Acta 37:301–316

    Google Scholar 

  • Gage J (2004) A qualitative description of normal gait. In: Gage J (ed) The treatment of gait problems in cerebral palsy. Mac Keith Press, London, pp 42–70

    Google Scholar 

  • Griffin P, Wheelhouse W, Shiavi R et al (1977) Habitual toe-walkers. a clinical and electromyographic gait analysis. J Bone Joint Surg Am 49(4):97–101

    Article  Google Scholar 

  • Grimston S, Nigg B, Hanley D et al (1993) Differences in ankle joint complex range of motion as a function of age. Foot Ankle 14(4):215–222

    Article  Google Scholar 

  • Hall J, Salter R, Bhalla S (1967) Congenital short tendo calcaneus. J Bone Joint Surg (Br) 49(4):695–697

    Article  Google Scholar 

  • Hemo Y, Macdessi S, Pierce R et al (2006) Outcome of patients after achilles tendon lengthening for treatment of idiopathic toe walking. J Pediatr Orthop 26(3):336–340

    Article  Google Scholar 

  • Hicks R, Durinick N, Gage J (1988) Differentiation of idiopathic toe-walking and cerebral palsy. J Pediatr Orthop 8(2):160–163

    Article  Google Scholar 

  • Hill R (1995) Ankle equinus. Prevalence and linkage to common foot pathology. J Am Podiatr Med Assoc 85(6):295–300

    Article  Google Scholar 

  • Hirsch G, Wagner B (2004) The natural history of idiopathic toe-walking: a long-term follow-up of fourteen conservatively treated children. Acta Pediatr 93:196–199

    Article  Google Scholar 

  • Kalen V, Adler N, Bleck E (1986) Electromyography of idiopathic toe walking. J Pediatr Orthop 6:31–33

    Article  Google Scholar 

  • Karol L, Concha M, Johnston C (1997) Gait analysis and muscle strength in children with surgically treated clubfeet. J Pediatr Orthop 17(6):790–795

    Google Scholar 

  • Kelly I, Jenkinson A, Stephens M et al (1997) The kinematic patterns of toe-walkers. J Pediatr Orthop 17(4):478–480

    Google Scholar 

  • Le Cras S, Bouck J, Brausch S et al (2011) Cincinnati Children’s Hospital Medical Center: evidence-based clinical care guideline for management of idiopathic toe walking. Guideline 040, pp 1–17. Available via http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/occupational-therapy-physical-therapy/. Accessed 1 Aug 2016

  • McMulkin M, Baird G, Caskey P et al (2006) Comprehensive outcomes of surgically treated idiopathic toe walkers. J Pediatr Orthop 26(5):606–611

    Article  Google Scholar 

  • McMulkin M, Gordon A, Tompkins B et al (2016) Long term gait outcomes of surgically treated idiopathic toe walkers. Gait Posture 44:216–220

    Article  Google Scholar 

  • Ming X, Brimacombe M, Wagner G (2007) Prevalence of motor impairment in autism spectrum disorders. Brain and Development 29:565–570

    Article  Google Scholar 

  • Papariello S, Skinner S (1985) Dynamic electromyography analysis of habitual toe-walkers. J Pediatr Orthop 5:171–175

    Article  Google Scholar 

  • Perry J (1985) Normal and pathologic gait. In: Bunch W (ed) Atlas of orthotics, 2nd edn. C.V. Mosby, St. Louis, pp 76–111

    Google Scholar 

  • Perry J (1992) Gait analysis: normal and pathological function. Slack Incorporated, Thorofare

    Google Scholar 

  • Pierz K, Õunpuu S (2013) Toe walking: how to know who to worry about. Paper presented at the 67th American Academy of Cerebral Palsy and Developmental Medicine Meeting, Milwaukee, 16–19 October 2013

    Google Scholar 

  • Pomarino D, Ramirez Llamas J, Pomarino A (2016) Idiopathic toe walking tests and family predisposition. Foot Ankle Spec 20(10):1–6

    Google Scholar 

  • Sawatzky B, Alvarez C, Beauchamp R et al (1999) Adaptations of gait on the contralateral limb in children with spastic hemiplegia. Paper presented at the 17th Congress of the International Society for Biomechanics, Calgary, 8–13 August 1999

    Google Scholar 

  • Shulman L, Sala D, Chu M et al (1997) Developmental implications of idiopathic toe walking. J Pediatr 130(4):541–546

    Article  Google Scholar 

  • Sobel E, Caselli M, Velez Z (1997) Effect of persistent toe walking on ankle equinus. Analysis of 60 idiopathic toe walkers. J Am Podiatr Med Assoc 87(1):17–22

    Article  Google Scholar 

  • Stott N, Walt S, Lobb G et al (2004) Treatment for idiopathic toe walking: results at skeletal maturity. J Pediatr Orthop 24(1):63–69

    Article  Google Scholar 

  • Stricker S, Angulo J (1998) Idiopathic toe walking: a comparison of treatment methods. J Pediatr Orthop 18(3):289–293

    Google Scholar 

  • Sutherland D, Olsen R, Cooper L et al (1980) The development of mature gait. J Bone Joint Surg Am 62(3):336–353

    Article  Google Scholar 

  • Tabrizi P, McIntyre W, Quesnel M et al (2000) Limited dorsiflexion predisposes to injuries of the ankle in children. J Bone Joint Surg 82-B(8):1103–1106

    Article  Google Scholar 

  • van Bemmel A, van de Graaf V, van den Bekerom M et al (2014) Outcome after conservative and operative treatment of children with idiopathic toe walking: a systematic review of the literature. Musculoskelet Surg 98:87–93

    Article  Google Scholar 

  • Van Kuijk A, Kosters R, Vugts M et al (2014) Treatment for idiopathic toe walking: a systematic review of the literature. J Rehabil Med 46:945–957

    Article  Google Scholar 

  • Walker J (1991) Musculoskeletal development: a review. Phys Ther 71(12):878–889

    Article  Google Scholar 

  • Westberry D, Davids J, Davis R et al (2008) Idiopathic toe walking: a kinematic and kinetic profile. J Pediatr Orthop 28(3):252–258

    Google Scholar 

  • Williams C, Tinley P, Curtin M et al (2012) Vibration perception thresholds in children with idiopathic toe walking gait. J Child Neurol 27(8):1017–1021

    Article  Google Scholar 

  • Williams C, Michalitsis J, Murphy A et al (2013) Do external stimuli impact the gait of children with idiopathic toe walking? A study protocol for a within-subject randomized control trial. BMJ Open 3(3):e0002389

    Article  Google Scholar 

  • World Health Organization (2007) International classification of functioning, disability and health: children and youth version: ICF-CY. World Health Organization, Geneva

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Shriners Gait Lab, Sunny Hill Health Centre for Children, Vancouver, BC, Canada

    Karen Davies, Lise Leveille & Christine Alvarez

  2. British Columbia Children’s Hospital, Vancouver, BC, Canada

    Lise Leveille & Christine Alvarez

Authors
  1. Karen Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lise Leveille
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine Alvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen Davies .

Section Editor information

  1. Institut for Biomechanics und Orthopedic, German Sport University Cologne, Cologne, Germany

    Gert-Peter Brüggemann

  2. Department of Computer Science, University of Houston, Houston, Texas, USA

    Zhigang Deng

  3. McIntosh Consultancy and Research, Sydney, New South Wales, Australia

    Andrew S. McIntosh

  4. Wilmington, Delaware, USA

    Freeman Miller

  5. C-Motion Inc., Germantown, USA

    W. Scott Selbie

  6. duPont Hospital for Children, Box 269, 19899, Wilmington, DE, USA

    Freeman Miller

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Davies, K., Leveille, L., Alvarez, C. (2018). Idiopathic Toe Walking. In: Handbook of Human Motion. Springer, Cham. https://doi.org/10.1007/978-3-319-14418-4_60

Download citation

Publish with us

Policies and ethics

Search

Navigation