Poster Presentation Australian Podiatry Conference 2019

Idiopathic toe walking research update.  (#103)

Antoni Caserta 1 2 , Cylie Williams 2 3 , Prue Morgan 2
  1. Monash Health, Pakenham
  2. Monash University , Frankston
  3. Peninsula Health, Frankston

Idiopathic toe walking (ITW) is a diagnosis of exclusion for children who walk on their toes, with no medical cause. This presentation summarises two recent systematic reviews, a Cochrane review, and a systematic review of published outcome measures used for ITW.

The Cochrane review aimed to assess the effects of conservative and surgical interventions on gait normalisation, ankle range of motion, and pain in children with ITW, identifying adverse effects of the interventions and the frequency of recurrence. The systematic review aimed to identify and evaluate the clinical utility, validity and reliability of the outcome measures and tools used to quantify lower limb changes within this population. 

Both reviews registered a protocol for search criteria, and data extraction.

There were 4 studies included within the Cochrane review, however only one study had data extracted reporting the difference between Botulinum Toxin A in addition to serial casting versus serial casting alone. These results indicated there was no clinically important differences between the two intervention groups for improvement in toe walking to under 50% at 12 months as reported by parents, no change in passive ankle joint dorsiflexion range of movement, or no change in recurrence of toe walking gait at 12 months.

There were 27 articles included for data extraction within the systematic review. Results indicated that interventional studies were more likely to report range of motion and gait analysis outcomes, than observational studies. The Alvarez classification tool in conjunction with Vicon motion system, appeared as the contemporary choice for describing ITW gait. There were no significant associations between the use of range of motion and gait analysis outcomes and any other outcome tool or assessment in all studies. There were limited reliability and validity reporting for many outcome measures.

The results of the Cochrane review indicate a need for future good quality, interventional, multiple-armed randomised control trials for treatment of ITW and to include functional outcomes for treatment effectiveness measurement.The systematic review also highlighted that a consensus statement should be considered to guide clinicians and researchers in the choice of the most important outcome measures for this population.