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Updated: Oct 19, 2026
Asymmetric Walkway: A Novel Behavioral Assay for Studying Asymmetric Locomotion
Published on: January 15, 2016
Voluntary (normal) versus obligatory (cerebral palsy) toe-walking in children: a kinematic, kinetic, and
J R Davids1, T Foti, J Dabelstein
1Motion Analysis Laboratory, Shriners Hospitals for Children, Greenville, South Carolina 29605, USA. jrdmd@greenville.infi.net
Insights
This study differentiates between normal and cerebral palsy toe-walking by analyzing gait deviations. Findings highlight the need for advanced analysis to distinguish primary from secondary gait issues in children with cerebral palsy.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Biomechanical Engineering
Background:
- Surgical management for toe-walking in cerebral palsy (CP) often involves complex, simultaneous interventions.
- Accurate surgical planning requires distinguishing primary gait deviations from secondary, compensatory ones.
Purpose of the Study:
- To compare gait patterns in children with CP and typically developing children who voluntarily toe-walk.
- To identify biomechanical factors contributing to toe-walking and differentiate primary CP-related deviations.
Main Methods:
- Employed computer-based gait analysis, including kinematic, kinetic, and electromyographic (EMG) assessments.
- Compared 32 typically developing children (normal and voluntary toe-walking) with 15 children with CP (obligatory toe-walking).
Main Results:
- Common gait deviations in both groups were attributed to biomechanical constraints of toe-walking.
- Deviations unique to the CP group were identified as primary, central nervous system-related issues.
Conclusions:
- Suggests a need for enhanced data collection and analysis techniques.
- Recommends incorporating diverse functional activities to better distinguish primary vs. secondary gait deviations in pediatric CP.
Abstract:
Surgical management of toe-walking gait in children with cerebral palsy currently favors simultaneous, multilevel soft-tissue and bony interventions. Formulation of such a surgical plan is based on our ability to determine which of the gait deviations present are primary and which are secondary or compensatory. To evaluate this issue further, 32 normal children, walking normally and voluntarily toe-walking, were compared to 15 children with cerebral palsy walking in an obligatory toe-walking gait pattern. Computer-based analysis of gait was performed for each child, including time-distance, kinematic, kinetic, and electromyographic analyses. Significant deviations common to both normal and cerebral palsy toe-walking groups were determined to be due, at least in part, to the biomechanical constraints associated with a toe-walking gait pattern. Deviations unique to the cerebral palsy group were thought to represent primary gait deviations related to the underlying injury to the central nervous system. This study identifies the need to develop more sophisticated techniques of data collection and analysis and supports the inclusion of more varied and demanding functional activities for distinguishing between primary and secondary gait deviations in children with cerebral palsy.
