Kinematic and Kinetic Gait Parameters Can Distinguish between Idiopathic and Neurologic Toe-Walking

The differentiation between mild forms of toe-walking (equinus) in cerebral palsy (CP) and idiopathic toe-walking (ITW) is often clinically challenging. This study aims to define kinematic and kinetic parameters using 3D gait analysis to facilitate and secure the diagnosis of “idiopathic toe-walking”. We conducted a retrospective controlled stratified cohort study. 12 toe-walking subjects per group diagnosed as ITW or CP were included and stratified according to age, gender and maximal dorsiflexion in stance. We collected kinematic and kinetic data using a three-dimensional optical motion analysis system with integrated floor force plates. Pairwise comparison between ITW and CP gait data was performed, and discriminant factor analysis was conducted. Both groups were compared with typically developing peers (TD). We found kinematic and kinetic parameters having a high discriminatory power and sensitivity to distinguish between ITW and CP groups (e.g., knee angle at initial contact (91% sensitivity, 73% specificity) and foot progression angle at midstance (82% sensitivity, 73% specificity)). The strength of this study is a high discriminatory power between ITW and CP toe-walking groups. Described kinematic parameters are easy to examine even without high-tech equipment; therefore, it is directly transferable to everyday praxis.

Development of a Core Set of Outcome Measures for Use During Treatment of Children With Idiopathic Toe Walking: A Delphi Study and Online Parent Survey

Introduction There is diversity in outcome measures used during monitoring and treatment of the exclusionary diagnosis idiopathic toe walking (ITW) in children. This diversity makes synthesis of treatment effects difficult. The primary aim of this research was to develop a core set of outcome measures identified by health professionals for use when undertaking treatment with children who have ITW. The secondary aims were to understand if parents agreed with this core set, and if parents believed they could undertake any of these measures in the absence of the clinician. Methods Study 1 was the development of consensus and agreement through the modified Delphi technique with 10 expert health professionals. The first round gathered questions and assessments for consensus, the second and third round enabled agreement with these questions and assessments. Study 2 was an online survey where parents of children who toe walked were invited to provide opinions on the importance of these measures and if they believed they may be able to collect the data about their child without the health professional being present. Results Ten health professionals provided 21 questions and assessments in Round 1 to measure treatment effectiveness for ITW in children. Following consensus and agreement by health professionals over the three rounds, there were nine questions and assessments presented to parent participants in Study 2. There were 34 parents who provided information about their satisfaction with toe walking assessments and treatments. There 27 parents provide detailed responses about the outcome questions and assessments, most parents in support of the core set identified by the experts. Parents also expressed a willingness to self-complete questions or be taught assessments to monitor their child’s progress. Conclusion This research developed a core set of questions and measures clinicians, and researchers could implement during health care provision and any research of children with ITW. Use of these measures will enable consistent data collection regardless of the setting and provide the foundation for large data pooling in future treatment research.

Taming Idiopathic Toe Walking: Examining the Toe Tamer® for Children Who Idiopathically Toe-Walk

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Idiopathic toe walking (ITW) causes significant physical impairment that affects a child’s occupational engagement. This research postulates a quasi-experimental study examining the responsiveness of a child with ITW using the Toe Tamer® protocol for 6 weeks during the COVID-19 pandemic. This research is relevant to the practice of OT by providing an individualized, accessible, cost-effective solution to ameliorate the effects of ITW in children. Primary Author and Speaker: M. Irma Alvarado Additional Authors and Speakers: Hannah Owens, Olivia Brand, and Sara Lieto Contributing Authors: Leigh Lehman, Ileana Seoane McCaigue

Idiopathic toe walking and heterozygous mutation in the NDGR1 gene: 2 clinical cases

В данной статье приводится описание двух клинических случаев пациенток с ходьбой на носках. В рамках диагностики обеим пациенткам был проведен генетический тест на наследственную сенсомоторную нейропатию, который выявил у одной пациентки мутацию в гене NDRG1 с редким вариантом c.1022G> A; p.arg341His (частота минорного аллеля < 0,01%), у другой пациентки обнаружен гетерогенный вариант c.1053_1082del и NM_001135242.1 p.Thr360_Gly369del. Данные мутации ассоциированы с болезнью Шарко–Мари–Тута (тип 4D), но ни у одной из пациенток клинически не было обнаружено данной наследственной нейропатии, в то же время диагноз идиопатической ходьбы на носках также сомнителен, поскольку в обоих случаях потребовалось достаточно серьезное лечение. Поэтому разумно предположить, что обе пациентки ходят на цыпочках по генетической причине. This article describes two clinical cases of patients with tiptoe walking. As part of the diagnosis, both patients underwent a genetic test for hereditary sensorimotor neuropathy, which revealed in one patient a mutation in the NDRG1 gene with a rare variant c.1022G> A; p.arg341his (minor allele frequency < 0.01%), in the other patient a heterogeneous variant c.1053_1082del and NM_001135242.1 p.thr360_gly369del was detected. These mutations are associated with Charcot–Marie–Toute disease (type 4D), but none of the patients were clinically diagnosed with this hereditary neuropathy, while the diagnosis of idiopathic toe-walking is also doubtful, since in both cases quite serious treatment was required. Therefore, it is reasonable to assume that both patients walk on tiptoe for a genetic reason.