Idiopathic toe walking Flashcards
what is the technical definition of idiopathic toe walking?
Characterized by forefoot walking through stance phase of gait cycle
No known medical cause
what would be a red flag when a child is a toe walker?
Toe-toe gait is bilateral and symmetrical (unilateral is a red flag). This would be a potential neurological cause.
what is the etiology for idiopathic toe walking?
unknown! Neurological, neuromuscular, neuropsychiatric, orthopedic disease, or other disorders of the central or peripheral nervous system are ruled out
can have a genetic component
what are the common co morbidities for idiopathic toe walking
Neuropsychiatric Disorders (ADHD, anxiety
Sensory Processing Disorders
Speech Delays
why should you care if a child is a idiopathic toe walker?
Diminished dorsiflexion ROM is associated with foot and ankle pain/pathology later in life
Risk of injury/deformity:
Pain, frequent falls, ankle sprain, postural compensations, bony changes with development
Social aspects of development:
Fatigue/inability to keep up with peers, bullying, social isolation
what are the postural changes if a child has a plantar flexor contracture?
ankle equines, hip flexion, gene recurvalum, lumbar lordosis
what is the typical gait development?
Heel strike typically emerges around 18-24 months of age
Toe walking can be a new walker gait pattern occasionally
Habitual toe walking is not considered a typical part of development
what is the primary impairment for toe walking?
Typically, positive exam findings in one or more of the following:
ADHD/anxiety
Oculomotor and/or vestibular impairments
Concern for Autism Spectrum Disorder
Sensory processing impairments (ie, sensory seeking or sensory avoiding)
what are the secondary impairments for toe walking?
Limited dorsiflexion ROM (<10 degrees knee ext)
Short hamstrings
Muscle weakness/poor PF power generation
Impaired balance
Pain
Pronation and/or knee hyperextension
Pronation is a common compensation for limited DF ROM
Supination is a red flag
A child that is a toe walk is experience supination during his gait pattern is this concerning and why?
supination is a red flag for neurological conditions
what are the key areas to address in a Childs evaluation that has idiopathic toe walking?
Family and medical history
Birth and developmental history
Sensory and behavioral history
When did the toe walking start (sudden or late onset is a red flag)
Percentage of time on toes, are there patterns?
What occurs when a child toe walks in terms of kinesiology and power outputs?
Limited power production -> Limited rapid ankle plantar flexion
Compensation for calf weakness or poor power production is to decrease functional DF ROM to limit required power production
what is the recommended intervention for a child that has 10+ degrees of ankle ROM when Childs knee is extended?
Stretching program to maintain
what is the recommended intervention for a child that has 0-10 degrees of ankle ROM when Childs knee is extended?
Stretching program, night splints, heel wedging to accommodate
what is the recommended intervention for a child that has <0 degrees of ankle ROM when Childs knee is extended?
Serial casting, orthopedic surgery, botulinum toxin (botox)*, may consider serial night splinting
T or F does limited Dorsiflexion REQUIRE foot management?
true
Limited dorsiflexion ROM requires foot management
what are the two “medical” management for dorsiflexion interventions?
serial casting
orthopedic surgery referral for tendon lengthening.
what can you use for night interventions?
night splinting fixed or serial
after DF is normalized how can you maintain the new ROM?
Orthotic support – foot orthotics, UCBL orthotics, SMOs, AFOs
Stretching
Balance – vision, vestibular, and/or proprioceptive components
Strengthening
Gait training
Manual therapy
what should the goals for treatment be for a child with toe walking?
10-15 degrees dorsiflexion with knee extended (in subtalar neutral!)
Toe walking <25% of the time throughout the day
No pain
Age-appropriate gross motor skills
Age-appropriate tripping/falling
Stretching program to manage calf length particularly during growth spurts
How long does treatment for ITW be?
Treatment for ITW can be 1-2+ year process due to high risk for recurrence
