Clinical impact of gait analysis and pedography in treatment decision-making for idiopathic toe walking: A Cross-sectional study.

Abstract

Background: Diagnosing idiopathic toe walking (ITW) and assessing its severity based solely on clinical examinations can be challenging, underscoring the need for advanced, objective diagnostic tools to guide orthopedic treatment strategies.

Aim: To test whether treatment strategies of children diagnosed with ITW based on clinical examination change when objective and quantitative data from three-dimensional gait analysis (3DGA) and pedography are incorporated.

Methods: Children diagnosed with ITW and referred for orthopedic treatment based on clinical examination were included. Ankle and knee kinematics and kinetics were recorded in a single session using 3DGA, while heel contact time was assessed with pedography. Based on ankle joint angles and moments, participants were classified as having no-to-mild or moderate-to-severe ITW according to a predefined severity classification. Statistical parametric mapping (SPM) provided detailed analysis of deviations in kinematic and kinetic gait patterns. The area under the receiver operating curve (AUC) assessed heel contact time's discriminative ability.

Results: Forty-seven children were included in the study. 3DGA classified 15 participants as having no-to-mild ITW and 32 as moderate-to-severe ITW. SPM analysis identified significant between-group differences in ankle kinematics and kinetics. Pedography demonstrated strong discriminative ability, with an AUC of 0.80.

Conclusion: Adding 3DGA and pedography to clinical assessment altered treatment decisions, shifting 15 of 47 children from planned orthopaedic intervention to conservative management, and emphasised that factors other than gastrocnemius‑soleus muscle‑tendon unit tightness should be considered.