Multiplanar kinematic deviations in idiopathic toe walking: A comparison with voluntary toe walking gait

Area of Science:

• Biomechanics
• Pediatric Gait Analysis
• Neuromuscular Disorders

Background:

• Idiopathic toe walking (ITW) is defined as persistent toe walking beyond age three without a known neuromuscular cause.
• While excessive ankle plantarflexion is characteristic, multiplanar lower limb and foot kinematic deviations in ITW are not fully understood.
• It remains unclear if these deviations are consequences of toe walking or specific to ITW.

Purpose of the Study:

• To compare the gait patterns of children with ITW to typically developing (TD) children during normal walking (TD-N) and voluntary toe walking (TD-TW).
• To identify specific kinematic differences in ITW gait compared to TD-N and TD-TW.

Main Methods:

• A retrospective study involving 44 children with ITW and 44 TD children.
• Three-dimensional lower limb and multi-segment foot kinematics were collected during normal and voluntary toe walking.
• Joint kinematics were analyzed using statistical parametric mapping, adjusted for speed and age.

Main Results:

• Both ITW and TD-TW groups exhibited reduced step length and velocity compared to TD-N.
• The TD-TW group showed reduced step width compared to TD-N.
• ITW-specific deviations included excessive ankle plantarflexion at mid-swing, increased knee and hip flexion during swing, and external hip rotation compared to TD-TW.

Conclusions:

• The gait pattern in voluntary toe walking does not fully replicate that of idiopathic toe walking.
• The findings suggest that ITW gait patterns involve adaptations beyond the biomechanical consequences of simply walking on toes.