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Idiopathic Toe Walking Can Be Differentiated from Cerebral Palsy Through Gait Analysis

Children who do not have cerebral palsy but who walk on their toes are often diagnosed with idiopathic toe walking (no known cause), or ITW, by excluding all other possible diagnosis. Toe walking occurs in the early years of childhood in many children, but if it persists beyond the age of five years, this should be investigated for the root cause.

The traditional suspected diagnosis for toe walking is cerebral palsy and other neurological (nerve) disorders, all of which should be ruled out before diagnosing ITW. While some children with ITW do have some tightening of the heel cords, some also just prefer to walk on the balls of their feet or their toes.

Earlier research has found, through quantitative gait analysis, that children with ITW tended to have increased ankle plantar flexion while standing and walking, and the knees showed some differences by hyperextending while standing. On the other hand, children with cerebral palsy had their knees partially bend while standing.

The authors of this study wanted to determine if children with ITW could normalize their gait on demand and how to use quantitative gait analysis to make an accurate diagnosis of ITW.

Researchers studied 51 children (33 boys) and compared their findings with 102 trials. The mean age of the children was 9.3 years (ranging from 6 to 18), most children were born at full term, ranging from 27 weeks to 42 weeks. The children were treated previously with serial stretch casting (15 patients), ankle foot orthosis (two patients), and botulinum injections (seven patients). None of the patients had undergone surgery for the toe walking.

In all children, the diagnosis of IWT was confirmed. Their gaits were analyzed and measurements of flexion and extension were taken. The most common finding among the children was that there was a disruption of all three ankle rockers, as found in previous studies, and most children preferred a plantar flexion of the ankle while making their steps. Also, 17 percent of the children were able to correct or normalize their gait on request. Seventy percent were able to make some changes to their gait, although they were not able to correct their gait completely.

The researchers were not able to find any differences in the range of motion between the children who could normalize their gaits and those who could not.

The authors conclude by suggesting children who are able to normalize their gait can be confirmed as having ITW.

References: David E. Westberry, MD, et al. Idiopathic Toe Walking. In Journal of Pediatric Orthopaedics. April/May 2008. Vol. 28. No. 3. Pp. 352-358.

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