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

Andreas Habersack,Hans-Peter Holzer,Martin Svehlik,Tanja Kraus,Stefan Franz Fischerauer

doi:10.3390/ijerph19020804

Abstract

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.

Highlights

Toe-walking is generally known as an absence or limitation of heel strike in the contact phase of the gait cycle [1,2]
Toe-walking children presented a loss of heel-rocker with initial forefoot floor contact and missing dorsiflexion during the single support stance phase as typical difference to typically developing peers (Figure 1a). To this missing heel-rocker both idiopathic toe-walking (ITW) and cerebral palsy (CP) toe-walkers showed a rapid increase in torsional moment in the ankle during loading response (Figure 1b), whereas a reduced second peak of the torsional moment occurred similar to typical walking at the end of the single stance phase begin of the second double support
We found the internally rotated foot during the single limb support to be significantly different from the ITW and control group (Figure 1d)

Summary

Introduction

Toe-walking is generally known as an absence or limitation of heel strike in the contact phase of the gait cycle [1,2]. Up to the age of 3 years, an appearance of toe-walking is assumed to be a common gait deviation [3]; beyond this age it might be considered as a pathological pattern. Epidemiologic data report a prevalence of ITW in children up to 12% with no differences in gender [12]. ITW children usually appear neurologically normal, possess normal muscle strength and selective control and demonstrate a preference for walking on the balls of the feet [13]. Children with ITW can present a reduced ankle range of motion [14]; there is evidence of children with ITW without any limitations [15]

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