The Prevalence and Course of Idiopathic Toe-Walking in 5-Year-Old Children

Karolinska Institutet, Department of Paediatric Orthopaedics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden.
PEDIATRICS (Impact Factor: 5.47). 07/2012; 130(2):279-84. DOI: 10.1542/peds.2012-0225
Source: PubMed


Children walking on their toes instead of with a typical gait, without evidence of an underlying medical condition, are defined as idiopathic toe-walkers. The prevalence of idiopathic toe-walking is unknown.
A cross-sectional prevalence study of 5.5-year-old children (n = 1436) living in Blekinge County, Sweden, was performed at the regular 5.5-year visit to the local child welfare center. Children were assessed for a history of toe-walking or whether they still walked on their toes. Additionally, all 5.5-year-old children (n = 35) admitted to the clinic for children with special needs in the county were assessed.
Of the 1436 children in the cohort (750 boys, 686 girls), 30 children (2.1%, 20 boys and 10 girls) still walked on their toes at age 5.5 years and were considered as active toe-walkers. Forty children (2.8%, 22 boys and 18 girls) had previously walked on their toes but had stopped before the 5.5-year visit and were considered as inactive toe-walkers. At age 5.5 years, the total prevalence of toe-walking was 70 (4.9%) of 1436. For children with a neuropsychiatric diagnosis or developmental delay, the total prevalence for active or inactive toe-walking was 7 (41.2%) of 17.
This study establishes the prevalence and- early spontaneous course of idiopathic toe-walking in 5.5-year-old children. At this age, more than half of the children have spontaneously ceased to walk on their toes. The study confirms earlier findings that toe-walking has a high prevalence among children with a cognitive disorder.

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Available from: Kristina Tedroff, Jun 27, 2015
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    ABSTRACT: : Idiopathic toe-walking (ITW) is a condition in which otherwise healthy children walk on their toes. The diagnosis is a diagnosis of exclusion. The aim of this study was to elucidate the occurrence of neuropsychiatric symptoms among 5- to 13-year-old children with ITW. : Fifty-one consecutive children (31 boys, 20 girls) with a mean age of 9 years and 1 month were referred to a pediatric orthopaedic unit for ITW. Evaluations included assessments by a pediatric orthopaedic surgeon and a pediatric neurologist and the parents were asked to complete the Five to Fifteen questionnaire, a validated screening tool for neuropsychiatric problems. The study cohort was compared with an age-matched normative group previously described. : In the study group, the percentage of children scoring above the 90th percentile, indicating difficulties, were for the different domains; motor skills 39.0%, executive functions 17.6%, perception 25.5%, memory 23.5%, language 23.5%, learning 25.9%, social skills 25.5%, and emotional/behavioural problems 21.6%. : Children with ITW as a group displayed more neuropsychiatric problems than a normative group of age-matched children. These findings merit future larger studies. Furthermore, when children with ITW are referred for orthopaedic or neurological assessment, a structured neuropsychiatric history is advisable and further neuropsychiatric investigations should be considered. : II.
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    ABSTRACT: Background: Idiopathic toe-walking (ITW) is a condition commonly seen by podiatric physicians. Because a toe-walking gait style is also caused by or associated with many other medical conditions, podiatric physicians should pay particular attention to ensuring an accurate diagnosis. There are many reported treatment options available for ITW. Therefore, a literature review was conducted to determine what treatment options are supported by the evidence as having the best long-term effect on ITW gait. Methods: After extraction of relevant articles, 21 manuscripts reporting treatment options for ITW gait were appraised against the levels of evidence. Results: From these articles, there was no single treatment option reported as having a long-term effect on the gait of children with ITW. There was support in the literature for surgical interventions, serial casting, and the use of botulinum toxin type A. There was limited evidence that footwear or orthoses changed the gait pattern. Conclusions: This review updates the knowledge of podiatric physicians, enhances how children who present with this gait style can be managed, and highlights areas for future research.
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    ABSTRACT: Objective To analyze the scientific evidence about treatment effectiveness in patients diagnosed with idiopathic toe walking. Search strategy A search was made for scientific articles on idiopathic toe walking and treatment within the PubMed and PEDro databases between 2009 and 2013. Study selection Five clinical trials that met the inclusion criteria were selected. Synthesis of results Treatments based on physiotherapy, casts, botulinum toxin and surgery have shown limited effectiveness in the correction of idiopathic toe walking, significant results have been found in joint dorsiflexion ranges. Conclusions Treatment based on motor control techniques as part of a multidisciplinary treatment seems to provide an effective approach in relation to the motor development of the subjects compared to other current treatments.
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