UBC Theses and Dissertations
Long-term follow-up of children with idiopathic toe walking Davies, Karen Rachel
Introduction: Toe walking may develop with early ambulation, but is considered abnormal in healthy children after three years of age. Idiopathic toe walking is a diagnosis of exclusion characterized by forefoot weight bearing and lack of heel contact with the floor. This condition may be associated with pain in the legs or feet, frequent tripping or falling, and ankle injuries. In British Columbia, treatment for toe walking varies from physiotherapy, casts or braces, Botulinum toxin A injections into calf muscles, and/or surgery. Little evidence exists regarding long-term treatment effects. Objectives: To determine the natural history of idiopathic toe walking and the long-term impact of treatment on gait outcomes and severity of toe walking. Potential activity limitations and participation restrictions were also explored. Methods: Gait analysis data and severity of toe walking were compared from baseline to follow-up in 44 adolescents and young adults diagnosed with idiopathic toe walking between 1997 and 2005 in a non-experimental retrospective cohort study. Participants were grouped as receiving no treatment other than stretching exercises (n=20) or treatment (n=24), including casting +/- Botulinum toxin A injections (n=23) or tendo-Achilles lengthening (n=1). Levels of activity and participation were assessed using the Pediatric Outcomes Data Collection Instrument for adolescents and the Medical Outcomes Study 36-Item Short Form Survey Instrument for young adults. Results: Ankle kinematics improved in the treatment group only whereas improved ankle kinetics and compensatory knee hyperextension were observed in both groups. Ankle moments remained atypical in 89% of the participants at follow-up. Clinical ankle dorsiflexion decreased over time in both groups. Statistically significant differences in severity at follow-up were found only in the treatment group (p<0.001). Adolescents and young adults scored 54% and 68%, respectively, above the general population mean in global functioning and physical capacity by self-report. Conclusions: The natural history of idiopathic toe walking indicates improved timing of ankle kinematics and improved ankle kinetics. Participants treated for toe walking as children demonstrated significant changes in kinematics, kinetics, and severity at follow-up. Despite perseverance in gait changes in both groups at follow-up, self-report questionnaires suggest there is minimal impact on activity and participation.
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