Gait abnormalities and ability to alter gait in children with idiopathic toe walking with a mild/moderate calf contracture

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.