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Validation of Parental Reports in Assessing Idiopathic Toe Walking Using Quantitative In-Shoe Device Measurements
Logan Morrison1,2, Susan Sienko1, Mark McMulkin3
1Shriners Children's Portland, Portland, OR.
Insights
Parental reports on childhood toe walking are fairly accurate for clinical use. However, in-shoe devices offer more objective data for assessing idiopathic toe walking (ITWp) and guiding treatment.
Area of Science:
- Pediatric Orthopedics
- Biomechanical Engineering
- Clinical Diagnostics
Background:
- Idiopathic toe walking (ITWp) affects 5-24% of children.
- Parental reports are crucial for ITWp assessment but can be unreliable.
- Objective validation of parental reports is needed.
Purpose of the Study:
- To validate parental reports of toe walking frequency against objective in-shoe device measurements.
- To assess the reliability of parental recall in ITWp diagnosis.
Main Methods:
- A multicenter study involving 20 children with persistent ITWp.
- Parents reported toe walking frequency on a 6-point scale.
- Children wore NURVV/RUN insoles for 7 days to record foot strike patterns.
- Agreement was analyzed using weighted Kappa statistics.
Main Results:
- Substantial agreement (k=0.688) was found for combined forefoot and midfoot contact.
- Fair agreement (k=0.381) was observed for isolated forefoot contact.
- Children with ITWp showed 61.7% forefoot, 15.3% midfoot, and 22.8% hindfoot contact.
Conclusions:
- Parental reports demonstrate relative accuracy for ITWp clinical management.
- Quantitative in-shoe devices provide objective data for ITWp assessment.
- In-shoe technology can enhance clinical decision-making and outcomes evaluation for ITWp.
Background:
Toe walking is prevalent among children, affecting 5% to 24% of the pediatric population. Clinicians rely on parental reports of frequency of toe walking to guide clinical decision making and outcomes assessment. However, recall accuracy and differing environments challenge the reliability of parental reports. This study aims to validate parental reports against quantitative in-shoe device measurements (NURVV/RUN).
Methods:
Twenty children with persistent idiopathic toe walking (ITWp) (mean age: 9.6y; 13 males, 7 females) from 8 pediatric orthopaedic specialty care sites participated in this multicenter study. Parents assessed toe walking frequency using a 6-point scale, while children wore NURVV/RUN insoles for 8 hours/day over 7 days. Insole sensors recorded foot strike patterns (rearfoot, midfoot, and forefoot), which were classified using the same severity scale. Agreement between parental reports and NURVV data was assessed using weighted Kappa statistics ( P <0.05).
Results:
Before intervention, children with ITWp exhibited daily walking patterns: 61.7% forefoot, 15.3% midfoot, and 22.8% hindfoot contact. Agreement analysis showed substantial agreement (k=0.688, P <0.001) for combined forefoot and midfoot contacts and fair agreement (k=0.381, P <0.005) for isolated forefoot contact.
Conclusion:
Parental reports of toe walking prevalence in their children are relatively accurate, supporting their use in clinical management. However, quantitative in-shoe devices provide a more objective and quantitative understanding of ITWp frequency and have the potential to guide clinical decision-making and outcomes assessment children with ITWp.
Level Of Evidence:
Level II-diagnostic study. See instructions to authors for a complete description of levels of evidence.
