Gait abnormalities and ability to alter gait in children with idiopathic toe walking with a mild/moderate calf contracture
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Updated: Sep 10, 2025
Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder
Published on: March 4, 2018
Mark L McMulkin1, Bruce A MacWilliams2, Susan E Sienko3
1Shriners Children's Spokane, 911 W 5th Ave, Spokane, WA 99204, USA.
Insights
Children with persistent idiopathic toe walking (ITWp) can voluntarily change their gait to a more typical pattern, improving foot and ankle function. However, some gait deviations persist even with this altered walking style.
Area of Science:
- Pediatric orthopedics
- Biomechanics
- Gait analysis
Background:
- Persistent idiopathic toe walking (ITWp) is a common pediatric condition.
- Children with ITWp and mild/moderate contractures may improve gait with intervention.
- Understanding gait alterations in ITWp is crucial for treatment.
Purpose of the Study:
- To compare self-selected toe walking with a "best-walk" pattern in children with ITWp.
- To analyze gait kinematics and kinetics in children with ITWp and mild/moderate contractures.
- To evaluate the ability of children with ITWp to modify their gait.
Main Methods:
- Prospective multi-site study of children aged 6-18 years with ITWp.
- Collected lower extremity kinematics, kinetics, and electromyography during self-selected and "best-walk" trials.
- Compared ITWp gait patterns to an age-matched typically developing cohort.
Main Results:
- Children with ITWp demonstrated increased hindfoot and forefoot plantarflexion during self-selected walking.
- Participants volitionally altered their gait to a "best-walk" pattern, improving kinematics and kinetics.
- 50% of limbs achieved a first rocker in the "best-walk" condition, indicating improved foot function.
Conclusions:
- Children with ITWp and mild/moderate contractures can voluntarily adopt a more foot-flat gait pattern.
- Gait alterations improve kinematic and kinetic parameters.
- Deviations from typical gait patterns may persist despite efforts to modify walking.
Background:
Idiopathic toe walking is a common pediatric condition with those who continue to walk on their toes beyond childhood described as having persistent idiopathic toe walking (ITWp). Children with ITWp and mild/moderate contractures might be able to alter their gait pattern to a more typical gait. The purpose of this study was to compare self-selected toe walking to a "best-walk" pattern for children with ITWp and mild/moderate gastrocnemius/soleus contractures.
Methods:
This prospective multi-site study recruited children with ITWp, aged 6-18 years, and physical exam dorsiflexion with knee extended from 10° plantarflexion to 5° dorsiflexion. Lower extremity kinematics with a multi-segment foot model were collected for self-selected and best-walk trials along with kinetics and electromyography. Variables were compared between conditions of self-selected walking ITWp, best-walk ITWp, and an age matched typically developing cohort.
Results:
Sixty-five children participated in this study. Both the hindfoot and forefoot had increased plantarflexion with self-selected walking. Despite having a mild/moderate contracture, this group could volitionally alter their gait pattern from self-selected to best-walk via overall dorsiflexion, resulting in improvements in hindfoot and forefoot kinematics, and ankle kinetics. These alterations led to improved summary metrics and required higher levels of motor control. Additionally, 50 % of the limbs achieved a first rocker in the best-walk condition.
Conclusion:
Children with ITWp and a mild/moderate plantarflexor contracture were able to volitionally alter their gait pattern to a more foot flat pattern. Deviations from typically developing gait remained even with foot flat walking.
