In the JournalsPerspectiveFrom OT Europe

Study cites prevalence of idiopathic toe walking in children from birth to 10 years of age

Investigators found 79% of children who had ever been toe walkers spontaneously developed typical gait by 10 years of age and did so without intervention or contractures of the ankle dorsiflexion.

In their previous study of 1,401 Swedish children who were 5.5 years old, researchers found a 5% prevalence of idiopathic toe walking. In their current study, 26 of the 63 children who were toe-walkers were assessed at 8 and 10 years of age. When children were 8 years old, their parents were asked via telephone if their child received either treatment or diagnosis since their child’s assessment at 5.5 years of age. Parents were asked the same question at their child’s 10-year-old follow-up. The children then underwent a neurological examination and orthopedic examination which focused on the lower extremities.

Results showed six out of the 26 children stopped toe walking at 8 years of age. By the time children were 10 years old, 50 out of the 63 children spontaneously stopped toe-walking. Investigators noted idiopathic-walking did not lead to contractures of the triceps surae. One subgroup of children was not considered idiopathic toe walkers because the children displayed early contracture of the ankle, according to the researchers. There were four children at 10 years old who still toe walked and demonstrated neurodevelopmental comorbidity. – by Monica Jaramillo

 

Disclosure s : The authors report no relevant financial disclosures.

Investigators found 79% of children who had ever been toe walkers spontaneously developed typical gait by 10 years of age and did so without intervention or contractures of the ankle dorsiflexion.

In their previous study of 1,401 Swedish children who were 5.5 years old, researchers found a 5% prevalence of idiopathic toe walking. In their current study, 26 of the 63 children who were toe-walkers were assessed at 8 and 10 years of age. When children were 8 years old, their parents were asked via telephone if their child received either treatment or diagnosis since their child’s assessment at 5.5 years of age. Parents were asked the same question at their child’s 10-year-old follow-up. The children then underwent a neurological examination and orthopedic examination which focused on the lower extremities.

Results showed six out of the 26 children stopped toe walking at 8 years of age. By the time children were 10 years old, 50 out of the 63 children spontaneously stopped toe-walking. Investigators noted idiopathic-walking did not lead to contractures of the triceps surae. One subgroup of children was not considered idiopathic toe walkers because the children displayed early contracture of the ankle, according to the researchers. There were four children at 10 years old who still toe walked and demonstrated neurodevelopmental comorbidity. – by Monica Jaramillo

 

Disclosure s : The authors report no relevant financial disclosures.

    Perspective
    Matthew E. Oetgen

    Matthew E. Oetgen

    Engstrom and Tedroff present the completion of their 10-year study looking at the prevalence and natural history of toe walking in a group of children from Sweden. Toe walking in children is a significant concern for many parents and a frequent reason for pediatric orthopedic surgery consultation. Limited information is available about the natural history of this condition to help consult families and guide treatment decisions, so this study is informative and useful in developing some general thoughts on treatment.

    The authors found about 80% of children diagnosed with toe walking without ankle contracture will have spontaneous resolution of this issue by age 10. Additionally, they found about 50% of children whose toe walking did not resolve by age 10 were diagnosed with a neurodevelopment disorder between 5.5 years old and 10 years old.

    This study allows practitioners to categorize toe walking as such: Idiopathic toe walkers have no ankle contractures on exam and this condition typically resolves by age 10 (80% of the time). Non-idiopathic toe walkers have associated ankle contracture, typically do not improve over time and likely will require treatment for gait improvement. Finally, it is important to remember any child who continues to toe walk after age 10 should be evaluated for an underlying neurodevelopmental condition.

    • Matthew E. Oetgen, MD
    • Division chief, orthopedic surgery and sports medicine Children’s National Health System Washington, DC

    Disclosures: Oetgen reports no relevant financial disclosures.