Abstract
Children that are diagnosed with Idiopathic Toe walking (cITW) are characterized by persistent toe-to-toe contacts. The objective of this study was to explore whether typical foot contact dynamics during walking predisposes cITW to a higher risk of falling. Twenty cITW and age-matched controls performed typical and toe walking trials. The gait parameters related to foot contact dynamics, vertical force impulses during stance, slip, and trip risk were compared for both groups. We found that cITW manifest less stable gait and produced significantly higher force impulses during push-off. Additionally, we found that cITW had a higher slip-initiation risk that was associated with higher foot contact horizontal and vertical velocities in addition to lower transitional acceleration of center of mass. We found that cITW exhibited a higher trip risk with toe clearance being significantly lower when compared to healthy counterparts. This study allowed for a quantitative description of foot contact dynamics and delineated typical from toe walking among cITW. Overall, the results indicate that cITW are less stable during typical walking and are prone to a higher risk of slip and trip-like falls.
Highlights
Toe walking is defined as walking on the forefeet as compared to a typical heel-toe gait pattern
Significant interaction effects were found between groups for push-off rate
No significant differences were observed for loading impulse, center of mass (COM) ascending impulse, and COM descending impulse, but interaction effects were found between groups and walking type for push-off impulse (p < 0.01)
Summary
Toe walking is defined as walking on the forefeet as compared to a typical heel-toe gait pattern. Toe touch can be observed in early ambulation, but it is considered to be atypical after three years [1,2]. The prevalence of Idiopathic Toe Walking (ITW) among children has been reported between 2–12 % of the child population [3]. Earlier research has reported an increased fall risk due to frequent tripping and pain in the leg or foot among children diagnosed with Idiopathic Toe Walking (cITW) [1,4]. Some researchers reported limited ankle dorsiflexion, functional and passive range-of-motion (ROM), which predisposes them to higher fall risk and ankle injuries [5]. The cause of toe walking in ITW may not be clear. Some researchers emphasize hyperactive reflexes and they have based current therapeutic strategies on this theory in the clinics [6,7,8]
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