Journal of Pediatric Neurology 2022; 20(04): 237-251
DOI: 10.1055/s-0042-1742583
Review Article

Idiopathic Toe-Walking: A Review from 1967 to 2021

1   Pediatric Physical Therapist, Private Practice, New York, New York
› Author Affiliations
Funding None.

Abstract

Idiopathic toe-walking (ITW) is considered a diagnosis of exclusion for which no underlying neurological, neuromuscular, neurodevelopmental, or orthopedic condition can be identified. The purpose of this review was to examine multiple aspects of ITW: natural history, evaluation, treatment, musculoskeletal manifestations, and developmental issues through the review of studies from the initial description of condition in 1967 to the present. From a PubMed search and review of reference lists of individual articles, 64 articles were selected and reviewed. The studied samples were variably described and often not well-defined. Gait analysis found gait characteristics associated with ITW that varied from normal. Children with ITW can be differentiated from children with cerebral palsy on the basis of several gait pattern features, but findings from electromyographic comparisons were variable. Treatments included orthoses, casting, botulinum toxin type A, and surgery. The evidence to support any specific treatment is limited by the small sample size and short duration of follow-up in the majority of studies. The inadequacy of the current literature suggests the need for a longitudinal multi-center study to more clearly define the population of children with ITW and to determine indications, timing, and effectiveness of the various available treatments.



Publication History

Received: 19 October 2021

Accepted: 24 December 2021

Article published online:
14 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Alvarez C, De Vera M, Beauchamp R, Ward V, Black A. Classification of idiopathic toe walking based on gait analysis: development and application of the ITW severity classification. Gait Posture 2007; 26 (03) 428-435
  • 2 Dietz F, Khunsree S. Idiopathic toe walking: to treat or not to treat, that is the question. Iowa Orthop J 2012; 32: 184-188
  • 3 Eastwood DM, Menelaus MB, Dickens DRV, Broughton NS, Cole WG. Idiopathic toe-walking: does treatment alter the natural history?. J Pediatr Orthop B 2000; 9 (01) 47-49
  • 4 Engström P, Tedroff K. The prevalence and course of idiopathic toe-walking in 5-year-old children. Pediatrics 2012; 130 (02) 279-284
  • 5 Engström P, Tedroff K. Idiopathic toe-walking: prevalence and natural history from birth to ten years of age. J Bone Joint Surg Am 2018; 100 (08) 640-647
  • 6 Engström P, Van't Hooft I, Tedroff K. Neuropsychiatric symptoms and problems among children with idiopathic toe-walking. J Pediatr Orthop 2012; 32 (08) 848-852
  • 7 Fanchiang HD, Geil M, Wu J, Chen YP, Wang YT. The effects of vibration on the gait pattern and vibration perception threshold of children with idiopathic toe walking. J Child Neurol 2015; 30 (08) 1010-1016
  • 8 Griffin PP, Wheelhouse WW, Shiavi R, Bass W. Habitual toe-walkers. A clinical and electromyographic gait analysis. J Bone Joint Surg Am 1977; 59 (01) 97-101
  • 9 Hall JE, Salter RB, Bhalla SK. Congenital short tendo calcaneus. J Bone Joint Surg Br 1967; 49 (04) 695-697
  • 10 Herrin K, Geil M. A comparison of orthoses in the treatment of idiopathic toe walking: A randomized controlled trial. Prosthet Orthot Int 2016; 40 (02) 262-269
  • 11 Hirsch G, Wagner B. The natural history of idiopathic toe-walking: a long-term follow-up of fourteen conservatively treated children. Acta Paediatr 2004; 93 (02) 196-199
  • 12 Kalen V, Adler N, Bleck EE. Electromyography of idiopathic toe walking. J Pediatr Orthop 1986; 6 (01) 31-33
  • 13 Kogan M, Smith J. Simplified approach to idiopathic toe-walking. J Pediatr Orthop 2001; 21 (06) 790-791
  • 14 Martín-Casas P, Meneses-Monroy A, Beneit-Montesinos JV. et al. The dynamic baropodometric profile of children with idiopathic toe-walking: a cross-sectional study. J Am Podiatr Med Assoc 2019; 109 (01) 50-56
  • 15 Papariello SG, Skinner SR. Dynamic electromyography analysis of habitual toe-walkers. J Pediatr Orthop 1985; 5 (02) 171-175
  • 16 Policy JF, Torburn L, Rinsky LA, Rose J. Electromyographic test to differentiate mild diplegic cerebral palsy and idiopathic toe-walking. J Pediatr Orthop 2001; 21 (06) 784-789
  • 17 Pomarino D, Ramírez Llamas J, Pomarino A. Idiopathic toe walking: tests and family predisposition. Foot Ankle Spec 2016; 9 (04) 301-306
  • 18 Sinclair MR, Lind AA, Knowlton JQ. The effect of persistent toe walking on the skeletal development of the pediatric foot and ankle. J Pediatr Orthop B 2018; 27 (01) 77-81
  • 19 Sobel E, Caselli MA, Velez Z. Effect of persistent toe walking on ankle equinus. Analysis of 60 idiopathic toe walkers. J Am Podiatr Med Assoc 1997; 87 (01) 17-22
  • 20 Szopa A, Domagalska-Szopa M, Gallert-Kopyto W, Kiebzak W, Plinta R. Effect of a nonsurgical treatment program on the gait pattern of idiopathic toe walking: a case report. Ther Clin Risk Manag 2016; 12: 139-146
  • 21 Westberry DE, Carpenter AM, Brandt A. et al. Surgical outcomes for severe idiopathic toe walkers. J Pediatr Orthop 2021; 41 (02) e116-e124
  • 22 Westberry DE, Davids JR, Davis RB, de Morais Filho MC. Idiopathic toe walking: a kinematic and kinetic profile. J Pediatr Orthop 2008; 28 (03) 352-358
  • 23 Williams CM, Tinley P, Curtin M, Nielsen S. Vibration perception thresholds in children with idiopathic toe walking gait. J Child Neurol 2012; 27 (08) 1017-1021
  • 24 Brunt D, Woo R, Kim HD, Ko MS, Senesac C, Li S. Effect of botulinum toxin type A on gait of children who are idiopathic toe-walkers. J Surg Orthop Adv 2004; 13 (03) 149-155
  • 25 Clark E, Sweeney JK, Yocum A, McCoy SW. Effects of motor control intervention for children with idiopathic toe walking: a 5-case series. Pediatr Phys Ther 2010; 22 (04) 417-426
  • 26 Crenna P, Fedrizzi E, Andreucci E, Frigo C, Bono R. The heel-contact gait pattern of habitual toe walkers. Gait Posture 2005; 21 (03) 311-317
  • 27 Davies K, Black A, Hunt M, Holsti L. Long-term gait outcomes following conservative management of idiopathic toe walking. Gait Posture 2018; 62: 214-219
  • 28 Hemo Y, Macdessi SJ, Pierce RA, Aiona MD, Sussman MD. Outcome of patients after Achilles tendon lengthening for treatment of idiopathic toe walking. J Pediatr Orthop 2006; 26 (03) 336-340
  • 29 Martín-Casas P, Ballestero-Pérez R, Meneses-Monroy A, Beneit-Montesinos JV, Atín-Arratibel MA, Portellano-Pérez JA. Neurodevelopment in preschool idiopathic toe-walkers. Neurologia 2017; 32 (07) 446-454
  • 30 Sätilä H, Beilmann A, Olsén P, Helander H, Eskelinen M, Huhtala H. Does botulinum toxin A treatment enhance the walking pattern in idiopathic toe-walking?. Neuropediatrics 2016; 47 (03) 162-168
  • 31 Tuncer D, Akalan EE, Caliskan MM, Temelli Y, Yigit P. Functional bandaging in children with idiopathic toe walking. J Am Podiatr Med Assoc 2021; 19-182
  • 32 Baber S, Michalitsis J, Fahey M, Rawicki B, Haines T, Williams C. A comparison of the birth characteristics of idiopathic toe walking and toe walking gait due to medical reasons. J Pediatr 2016; 171: 290-293
  • 33 Bartoletta J, Tsao E, Bouchard M. A retrospective analysis of nonoperative treatment techniques for idiopathic toe walking in children: outcomes and predictors of success. PM R 2021; 13 (10) 1127-1135
  • 34 Brouwer B, Davidson LK, Olney SJ. Serial casting in idiopathic toe-walkers and children with spastic cerebral palsy. J Pediatr Orthop 2000; 20 (02) 221-225
  • 35 Engelbert R, Gorter JW, Uiterwaal C, van de Putte E, Helders P. Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness?. BMC Musculoskelet Disord 2011; 12: 61
  • 36 Fanchiang HD, Geil MD, Wu J, Ajisafe T, Chen YP. The effects of walking surface on the gait pattern of children with idiopathic toe walking. J Child Neurol 2016; 31 (07) 858-863
  • 37 McMulkin ML, Gordon AB, Tompkins BJ, Caskey PM, Baird GO. Long term gait outcomes of surgically treated idiopathic toe walkers. Gait Posture 2016; 44: 216-220
  • 38 Michalitsis J, Murphy AT, Rawicki B, Haines TP, Williams C. Full length foot orthoses have an immediate treatment effect and modify gait of children with idiopathic toe walking. Gait Posture 2019; 68: 227-231
  • 39 O'Sullivan R, Munir K, Keating L. Idiopathic toe walking—a follow-up survey of gait analysis assessment. Gait Posture 2019; 68: 300-304
  • 40 O'Sullivan R, O'Brien T. Idiopathic toe walking: a gait laboratory review. Ir Med J 2015; 108 (07) 214-216
  • 41 Thielemann F, Rockstroh G, Mehrholz J, Druschel C. Serial ankle casts for patients with idiopathic toe walking: effects on functional gait parameters. J Child Orthop 2019; 13 (02) 147-154
  • 42 Williams C, Tinley PD, Curtin M, Nielsen S. Foot and ankle characteristics of children with an idiopathic toe-walking gait. J Am Podiatr Med Assoc 2013; 103 (05) 374-379
  • 43 Williams CM, Tinley P, Curtin M, Wakefield S, Nielsen S. Is idiopathic toe walking really idiopathic? The motor skills and sensory processing abilities associated with idiopathic toe walking gait. J Child Neurol 2014; 29 (01) 71-78
  • 44 Pomarino D, Ramírez Llamas J, Pomarino A. Idiopathic toe walking: family predisposition and gender distribution. Foot Ankle Spec 2016; 9 (05) 417-422
  • 45 Fox A, Deakin S, Pettigrew G, Paton R. Serial casting in the treatment of idiopathic toe-walkers and review of the literature. Acta Orthop Belg 2006; 72 (06) 722-730
  • 46 Williams CM, Michalitsis J, Murphy AT, Rawicki B, Haines TP. Whole-body vibration results in short-term improvement in the gait of children with idiopathic toe walking. J Child Neurol 2016; 31 (09) 1143-1149
  • 47 Williams CM, Tinley P, Curtin M. The Toe Walking Tool: a novel method for assessing idiopathic toe walking children. Gait Posture 2010; 32 (04) 508-511
  • 48 Eastwood DM, Dennett X, Shield LK, Dickens DRV. Muscle abnormalities in idiopathic toe-walkers. J Pediatr Orthop B 1997; 6 (03) 215-218
  • 49 Engström P, Gutierrez-Farewik EM, Bartonek A, Tedroff K, Orefelt C, Haglund-Åkerlind Y. Does botulinum toxin A improve the walking pattern in children with idiopathic toe-walking?. J Child Orthop 2010; 4 (04) 301-308
  • 50 Jacks LK, Michels DM, Smith BP, Koman LA, Shilt J. Clinical usefulness of botulinum toxin in the lower extremity. Foot Ankle Clin 2004; 9 (02) 339-348
  • 51 Accardo P, Morrow J, Heaney MS, Whitman B, Tomazic T. Toe walking and language development. Clin Pediatr (Phila) 1992; 31 (03) 158-160
  • 52 Katz MM, Mubarak SJ. Hereditary tendo Achillis contractures. J Pediatr Orthop 1984; 4 (06) 711-714
  • 53 Stricker SJ, Angulo JC. Idiopathic toe walking: a comparison of treatment methods. J Pediatr Orthop 1998; 18 (03) 289-293
  • 54 Kelly IP, Jenkinson A, Stephens M, O'Brien T. The kinematic patterns of toe-walkers. J Pediatr Orthop 1997; 17 (04) 478-480
  • 55 Engström P, Bartonek Å, Tedroff K, Orefelt C, Haglund-Åkerlind Y, Gutierrez-Farewik EM. Botulinum toxin A does not improve the results of cast treatment for idiopathic toe-walking: a randomized controlled trial. J Bone Joint Surg Am 2013; 95 (05) 400-407
  • 56 Shulman LH, Sala DA, Chu MLY, McCaul PR, Sandler BJ. Developmental implications of idiopathic toe walking. J Pediatr 1997; 130 (04) 541-546
  • 57 Hicks R, Durinick N, Gage JR. Differentiation of idiopathic toe-walking and cerebral palsy. J Pediatr Orthop 1988; 8 (02) 160-163
  • 58 Jahn J, Vasavada AN, McMulkin ML. Calf muscle-tendon lengths before and after Tendo-Achilles lengthenings and gastrocnemius lengthenings for equinus in cerebral palsy and idiopathic toe walking. Gait Posture 2009; 29 (04) 612-617
  • 59 McMulkin ML, Baird GO, Caskey PM, Ferguson RL. Comprehensive outcomes of surgically treated idiopathic toe walkers. J Pediatr Orthop 2006; 26 (05) 606-611
  • 60 Rose J, Martin JG, Torburn L, Rinsky LA, Gamble JG. Electromyographic differentiation of diplegic cerebral palsy from idiopathic toe walking: involuntary coactivation of the quadriceps and gastrocnemius. J Pediatr Orthop 1999; 19 (05) 677-682
  • 61 Stott NS, Walt SE, Lobb GA, Reynolds N, Nicol RO. Treatment for idiopathic toe-walking: results at skeletal maturity. J Pediatr Orthop 2004; 24 (01) 63-69
  • 62 Levine MS. Congenital short tendo calcaneus. Report of a family. Am J Dis Child 1973; 125 (06) 858-859
  • 63 Perry J. Gait Analysis: Normal and Pathological Function. Thorofare NJ: SLACK Inc; 1992: 157-159
  • 64 Pistilli EE, Rice T, Pergami P, Mandich MB. Non-invasive serial casting to treat idiopathic toe walking in an 18-month old child. NeuroRehabilitation 2014; 34 (02) 215-220
  • 65 Williams CM, Tinley P, Curtin M, Nielsen S. Hand preference in children with an idiopathic toe walking gait. Acta Paediatr 2012; 101 (03) e140-e141
  • 66 Sala DA, Shulman LH, Kennedy RF, Grant AD, Chu MLY. Idiopathic toe-walking: a review. Dev Med Child Neurol 1999; 41 (12) 846-848
  • 67 Sutherland DH, Olshen R, Cooper L, Woo SL-Y. The development of mature gait. J Bone Joint Surg Am 1980; 62 (03) 336-353