Free Paper Australian Podiatry Conference 2019

Exploring health professionals understanding of evidence and use of different treatment strategies to manage idiopathic toe walking (#26)

Cylie Williams 1 , Kelly Gray 2 , Nina Davies 3 , Marybeth Barkocy 4 , Michael Fahey 5 , Jane Simmonds 6 , Pasquale Accardo 7 , Deborah Eastwood 8 , Verity Pacey 2
  1. Monash University, Frankston, VIC, Australia
  2. Macquarie University, Macquarie Park
  3. Staffordshire University, Stoke on Trent
  4. University of New Mexico, Albuquerque
  5. Monash Children's Hospital, Clayton
  6. Great Ormond Street Institute of Child Health, London
  7. Virginia Commonwealth University School of Medicine, Richmond
  8. Great Ormond St Hospital and University College, London


Idiopathic toe walking (ITW) is an exclusionary diagnosis1 and varies in severity, from those children with full range of ankle motion2, to those with associated ankle equinus2. Many clinicians are faced with challenges in understanding available evidence-based treatment options in the absence of an evidence based treatment pathway. The primary aim of this research was to understand the agreement between health professionals’ knowledge of evidence for common treatment strategies for ITW and if the health professional's support these strategies being used in clinical practice.



This was an international cross-sectional online survey between July 2017 and March 2018. This survey was open to registered health professionals who treat children with ITW. This survey was advertised through professional associations, social media and special interest groups.  The survey had two components: 1)General demographic variables and variables relating to knowledge of evidence about ITW treatments and 2)Their support for common treatment strategies. Additional data on treatments, referrals, and preference were collected. The Kappa statistic was used to describe the intra-rater agreement between evidence knowledge and support. Regression analyses were used to understand strategy use preference of the 10 most commonly preferred treatments.



There were 908 international survey responses primarily from medical doctors (n=24), orthotists (n=80), physiotherapists (n=589) and podiatrists (n=149). Kappa agreement for paired correct responses determined a fair agreement for evidence support knowledge for four strategies including Watch and Wait (Kappa=0.24), Stretching (Kappa=0.30), Sensory Integration Strategies (Kappa=0.40) and Motor Control Strategies (Kappa =0.24) and moderate agreement for thirteen others. No strategies had greater than moderate agreement between knowledge of evidence and the support for the strategy being used. Profession, country of practice, average number of children treated per week, and not correctly identifying the evidence factored into many of the most commonly used strategies for ITW (p<0.05). 


Discussion and Clinical Relevance

The results from this study confirm a large variety of interventions are utilised for the management of ITW around the world. Furthermore, there remains a disconnect between health professional's understanding of the evidence of common treatment strategies of ITW and a consensus for the treatment of this condition.


  1. 1. Williams CM, Tinley P, Curtin M: The Toe Walking Tool: a novel method for assessing idiopathic toe walking children. Gait & Posture 2010, 32:508—511. 2. Davies K, Black A, Hunt M, Holsti L: Long-term gait outcomes following conservative management of idiopathic toe walking. Gait & Posture 2018, 62:214-219.