The management of idiopathic toe walking

Area of Science:

• Pediatric Orthopedics
• Pediatric Physical Therapy
• Clinical Consensus

Background:

• Idiopathic toe walking (ITW) is a common pediatric condition with varied management approaches.
• Lack of standardized guidelines can lead to inconsistent clinical practice and outcomes.
• A consensus-based approach is needed to establish best practices for ITW assessment and management.

Purpose of the Study:

• To achieve expert consensus on the best practice for the assessment and management of children with idiopathic toe walking (ITW).
• To establish a benchmark for practitioners to ensure consistent and reliable care for children with ITW.
• To reduce geographical variability in the practice and outcomes for ITW.

Main Methods:

• A Delphi approach was employed with members from the British Society of Children's Orthopaedic Surgery (BSCOS) and the Association of Paediatric Chartered Physiotherapists (APCP).
• Two rounds of Delphi surveys were conducted, followed by a final consensus meeting to refine and approve statements.
• Descriptive statistics were used to analyze survey results, adhering to the AGREE checklist for reporting.

Main Results:

• Initial Delphi rounds identified 37 statements requiring further discussion, leading to a revised set of 29 statements in the second round.
• After the second round, 12 statements reached consensus, with 4 rejected and 13 inconclusive.
• A final consensus meeting resulted in 31 approved statements, establishing a benchmark for ITW care.

Conclusions:

• Consensus statements provide a strong body of opinion where evidence is limited, acting as a benchmark for clinical care.
• These guidelines will assist clinicians in managing children with ITW, ensuring consistent and reliable practice.
• The published consensus document can be shared with caregivers and patient groups to improve understanding and consistency of care.