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[Idiopathic toe walker child. Diagnosis and spontaneous evolution]
1Service de rééducation orthopédique et traumatologique, hôpital national de Saint-Maurice, 14, rue du Val dOsne, 94410, Saint-Maurice, France
Insights
Idiopathic toe walking often resolves spontaneously by age 8, especially when ankle dorsiflexion exceeds 10 degrees. Persistent cases with limited dorsiflexion may require intervention.
Area of Science:
- Pediatrics
- Orthopedics
- Neurology
Background:
- Idiopathic toe walking is a common gait abnormality in children.
- Understanding its natural history and predictors of resolution is crucial for clinical management.
Purpose of the Study:
- To analyze clinical and etiological aspects of idiopathic toe walking.
- To determine the natural evolution without treatment and optimal age for correction.
Main Methods:
- Retrospective analysis of 69 children admitted between 1973 and 1998.
- Review of 41 children during growth, with only 6 receiving treatment.
- Assessment of ankle dorsiflexion (knee extended and flexed) and family history.
Main Results:
- Toe walking most common at 12-18 months; initial examination between 1-4 years.
- Normal neurological examination in 46/69 children; no neurological impairment identified.
- Spontaneous correction occurred in 32 cases (3-8 years) with >10 degrees ankle dorsiflexion (knee extended).
- Persistent toe walking (>10 years) observed in 4 cases with <10 degrees dorsiflexion (knee extended).
Conclusions:
- Idiopathic toe walkers with >10 degrees ankle dorsiflexion (knee extended) often resolve spontaneously.
- Cases with triceps contracture and <10 degrees dorsiflexion may require interventions like triceps lengthening.
Aim Of The Study:
To analyse the clinical, the aetiological aspects, the evolution without treatment and the age of correction.
Material:
This history of 69 children admitted between 1973 and 1998 was analysed. Forty-one were reviewed during the growth; only 6 were treated.
Results:
The toe walking was most often observed at the beginning of the walk between the age of 12 and 18 months. The first examination was made between 1 and 4 year old. The ankle dorsiflexion was the same, knee extended or flexed for 41 children and different in 23 cases. Identical cases were present in the family in 16 of 33 when the history family was analysed. The neurological examination was normal in 46 cases. None of the 69 children had a neurological impairment. In 32 cases, spontaneous correction occurred between 3 and 8 years: all these cases presented an ankle dorsiflexion over 10 degrees knee extended. The toe walking persisted in two cases at 10 years and in two cases at 12 and 13 years: the dorsiflexion was under 10 degrees, knee extended at initial examination in these cases.
Discussion And Conclusion:
It is possible to differentiate the toe walkers with more than 10 degrees of ankle dorsiflexion knee extended where the correction is possible without treatment and the cases with triceps contracture and less than 10 degrees of ankle dorsiflexion where the correction without triceps lengthening is questionnable.
