Idiopathic Toe Walking

Question 1

Define toe walking

Answer 1

• Observed absence or limitation of heel strike in contact phase of gait cycle
• Absence of heel rocker (1st rocker of gait)
• Negative impact on the ankle rocker & its presence & timing

Question 2

Idiopathic toe walking (ITW) is

Answer 2

• Diagnosed after age 3
• Able to self-correct
• May have family member with ITW
• May or may not have ankle equinus
• Not gender specific

Question 3

ITW is associated with

Answer 3

• Family history
• Speech delay
• Left handedness
• Sensory processing disorder
• Delay in some gross motor skills
• Ankle equinus
• Postnatal complications

Question 4

Evidence for treatment of ITW based on level

Answer 4

• 1: Botox is equivalent to serial casting alone (equinus)
• 2: Surgical Tendo-achilles lengthening (equinus)
• 3: Augmented verbal feedback (amount of toe walking)
• 4: Orthotics/AFO (amount of toe walking)
• 5: Stretching/strengthening (equinus/amount)

Question 5

Take home considerations for ITW

Answer 5

• Growing connection b/w sensory processing disorders *SPD) and autism spectrum disorder (ASD)
• Intervention for SPD does not seem to demonstrate long term gait changes
• Serial casting improves ankle PROM but is not sustainable by itself
• Changing habitual gait pattern is challenging especially in children with ASD