Idiopathic toe walking

Question 1

What is idiopathic toe walking?

Answer 1

Absence of heel strike during initial contact, and foot does not make full contact during stance phase

Question 2

What conditions should be ruled out in the differential diagnosis?

Answer 2

• CP
• Muscular dystrophy
• PROM deficit
• Sensory processing issues
• Autism spectrum disorder
• Family trait

Question 3

When is gait condsidered idiopathic toe walking?

Answer 3

• Present in children older than 2 without signs of neurological, orthopedic, or psychiatric diseases
• Bilateral

Question 4

Describe toe awalking gait

Answer 4

1. Early heel rise
2. Plantar flexion in stance
3. Plantar swing phase
   * shorter step lengths
   * increased anterior pelvic tilt
   * knee hyper extension in stance and swing
   * excessive pronation coupled with foot eversion and toe outing during stance phase

Question 5

Possible reasons for idiopathic toe walking

Answer 5

• Sensory interpretation – imbalance between spinothalamic and lemniscal systems
• Hypotonia & hyporesponsive vestibular system
• Persistent immature pattern – typical 3-6 months after onset of gait theoretically but little research evidence
• Trunk/core control
• Bowel/bladder dysfunction
• Time in walkers/jumpers

Question 6

Implications of unresolved toe walking

Answer 6

• Reduced range of motion
• Balance and coordination issues
• Chronic pain, joint problems, and impaired function in the feet, ankles, knees, and lower back.
• Anterior talofibular ligament vulnerable to injury
• Muscle imbalance and tightness

Question 7

PT treatment options for idiopathic toe walking

Answer 7

• Stretching: exercises to stretch the calf muscles and Achilles tendon, which can help improve flexibility and encourage a normal gait.
• Range of Motion Exercises: help increase the flexibility and movement of the ankle and foot.
• Gait Training: Techniques to help the child walk with a more natural heel-to-toe pattern and improve balance.
• Strengthening Exercises: Exercises to strengthen the muscles in the lower leg and foot to support a normal gait.

Question 8

Other interventions for idiopathic toe walking

Answer 8

• Serial casting
• AFOs
• Botox injections
• Surgery: lengthen Achilles tendon or calf muscles
• Observation: see if it resolves on its own for a period of time