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Effect of persistent toe walking on ankle equinus. Analysis of 60 idiopathic toe walkers
E Sobel1, M A Caselli, Z Velez
1New York College of Podiatric Medicine, New York, USA.
Insights
Idiopathic toe walking in children may lead to ankle equinus, a condition limiting ankle flexibility. Early interventions are recommended to prevent persistent toe walking and potential long-term complications.
Area of Science:
- Pediatric Orthopedics
- Developmental Pediatrics
- Gait Analysis
Background:
- Idiopathic toe walking is a common gait abnormality in children.
- Understanding its natural history and potential complications is crucial for effective management.
- Limited range of ankle dorsiflexion may be associated with persistent toe walking.
Purpose of the Study:
- To investigate the natural history of idiopathic toe walking in children.
- To examine the relationship between ankle dorsiflexion range and age in toe walkers.
- To identify potential risk factors for developing ankle equinus.
Main Methods:
- A cohort of sixty children diagnosed with idiopathic toe walking (age 1-15 years) was evaluated.
- Assessment included gait analysis, passive ankle dorsiflexion measurements, and age correlation.
- Children were categorized based on ankle dorsiflexion range and gait pattern.
Main Results:
- Most children exhibited typical developmental milestones and intermittent toe walking.
- Forty-six percent of participants had 0 degrees or less of passive ankle dorsiflexion.
- Children with equinus gait had significantly less ankle dorsiflexion compared to others.
- Ankle dorsiflexion decreased with age, from 12 degrees in 1-2 year olds to -4 degrees in 6-15 year olds.
Conclusions:
- Persistent toe walking may be linked to the development of ankle equinus in some children.
- A decline in ankle dorsiflexion with age suggests a potential progression of the condition.
- Early intervention strategies should be considered to address idiopathic toe walking and prevent equinus development.
Abstract:
Sixty idiopathic toe walkers (age range 1 to 15 years) were evaluated to determine the natural history of toe-to-toe gait and the relationship between the range of ankle dorsiflexion and increasing age. The majority of toe walkers had a normal birth weight (average 7.06 pounds), walked on time (average 11.14 months), began toe walking immediately (87%), stood plantigrade (90%), were able to demonstrate a heel-toe gait (88%), and toe walked intermittently (68%). Forty-six percent of all toe walkers were found to have 0 degree or less of passive ankle dorsiflexion. Equinus toe walkers (mean dorsiflexion -5.2 degrees) had significantly less dorsiflexion than the remaining toe walkers (mean dorsiflexion 16.9 degrees; p < 0.01). An average of 12 degrees of dorsiflexion was resent in the 1-to 2-year age group, which gradually diminished to -4 degrees in the 6- to 15-year age group. It appears that there may be a relationship between persistent toe walking and the development of ankle equinus in some children and therefore interventions should be considered to inhibit the toe walking progression.