Idiopathic Toe Walking (ITW )

1. Idiopathic Toe Walking (ITW )
Dr.Akshay Raj ChandraPT
Dr.Akshay Raj Chandra PT
CONSULTANT PEDIATRIC
PHYSIOTHERAPIST

2. Defination
Brief Explanation
KEYPOINT
Features of idiopathic Toe walking:-
What cause of idioapathic toe walking
Presentation

3. Diagnosis
Diagnosis TEST
Physical E amination :-
Evaluation
WHY Idiopathic toe walking (ITW) need Treatment
Treatment options may be need
Can ITW be Treated
Physical Therapy Intervention

4. Idiopathic Toe Walking
Defination
Idiopathic toe walking is a term used to define a gait in
which a person walks with a toe‐toe gait pattern without
any known correlated etiology
Idiopathic toe waliking is when your child continues to
walking their tip toe is beyond _three_years_of_age

5. BRIEF :-
Toe walking refers to a walking pattern in
which a child walks on the balls of their feet
and there is no contact between the heels and
the ground. There are many medical reasons
for this type of walking pattern. This handout
is about a specific type of toe walking called
idiopathic toe walking.

6. Some children with idiopathic toe walking are able to walk
with their feet flat when asked to do so. When these
children wear shoes, they might not walk on their toes.
Their toe walking is often exaggerated when they walk
bare-footed from one room to another or when they walk
on surfaces that have increased tactile sensations (carpet,
cold tile, grass). These children typically do not have
tightness in their Achilles

7. KEY POINT:-
Idiopathic toe walking is when a child continues to walk on their tip toes beyond
three years of age.
•Idiopathic toe walking can lead to tight calf muscles and decreased movement of
the ankles.
•Treatment for children younger than six years of age include calf stretches,
Achilles tendon stretches and sit to stand exercises.
•Treatment for children six years of age and older include calf stretches and other
exercises including marching on the spot, walking uphill and on uneven surfaces, heel
walking and squats.

8. Features of idiopathic Toe walking :-
Although we do not really know why some children prefer to walk on their
toes, we do know that
Idiopathic toe walkers
walk on tip toes on both sides
are constantly balancing on their toes
are physically able to keep up with other children their age
walk with straight knees
will often be able to stand with their feet flat on the ground
Often have family history of toe walking

9. What cause of idioapathic toe walking :-
Tactile processing:anincreasedresponsetotouchsensations
Alteredproprioceptiveprocessing(sensingthebody’spositioninspace)
Vestibularprocessing(maintainingbalance)
Visualprocessing
Flexibility oflegandfootmuscles
Overall bodystrength
Family history:parentsorsiblingswhohaveahistoryoftoewalking

10. Presentation :-
Patient walks with a bilateral toe to toe gait intermittently
or consistently
They do not typically present with pain
They may or may not have tight heel cords with decreased
ankle dorsi‐flexion and possibly not be able to stand in
plantigrade position if have significant equinas contractures

11. Diagnosis
Past Medical/Surgical history to include birth history,
developmental milestone achievement, evaluation of family history
for progressive neuromuscular conditions,
.Review of system
Thorough history with specific attention to musculo‐skeletal and
neurologic symptoms especially bowel/bladder pattern difficulties

12. Diagnosis TEST:-
if patient is a chronic toe‐toe walker‐with abnormal neurologic
exam and/or abnormal bowel/bladder function recommend
getting an MRI of the brain/spine
•If positive Gowers sign obtain CK blood level
•Consider MRI of brain and spine and referral to orthopaedic
surgeon, even if no neurologic signs/symptoms, if despite casting,
continues to toe walk and presents with significant equinus
contractures

13. Physical E amination :-
Specific attention to musculo‐skeletal and neurologic exams.
In regard to musculo‐skelatal exam, make sure to evaluate
ankle motion and gait.
In regard to neurologic exam, make sure to specifically
check for the following: DTRs, muscle wasting, babinski,
clonus, hypertonia, gowers sign, and signs of spinal
dysraphism (spinal dimple, hairy patch).

14. Evaluation
Range of Motion
Strength
(ROM)
Posture/Alignment
Balance
Gait
Sensory processing screening

15. WHY Idiopathic toe walking (ITW) need
Treatment
Physical Symptom
Weight bearing skeleton will adapt form to function, especially in young children
•Hypertrophy of talar neck
•Underdeveloped calcaneus
Pain
•Calf pain and increased calluses and corns on balls of feet.
Soft tissue problems
•Tendency towards pes cavus
•Fixed achillestendon tightness and calf contractures

16. Soft tissue problems
•Tendency towards pes cavus
•Fixed achilles tendon tightness and calf contractures
Neuro Developmental Impairment
•Strong evidence for increase ankle sprains with gastroc tightness
•Balance
•Vestibular seeking?
•Back pain?

17. Can ITW be treated :-
For young children with idiopathic toe walking without Achilles’
tendon contractures, watching and waiting is an option. Some
younger children benefit from physical therapy where they are
taught how to stretch their legs, feet and toes. Night-time bracing
with plastic orthotics may be helpful. In some cases, idiopathic toe
walking may resolve on its own. For preschool and older children with
idiopathic toe walking with Achilles’ tendon contractures, some of
these treatment options may be needed

18. These treatment options may be needed
Physical Therapy: This involves stretching, strengthening, gait training and home exercise.
Occupational Therapy: This involves helping your child learn sensory integration strategies.
Orthotics: Plastic splints can be worn on the feet and ankles during the night to maintain
the stretch/flexibility of the Achilles’ tendons. Occasionally, they are also worn during
the day.
Serial Casting: This involves a series of casts to stretch your child’s Achilles’ tendons.
Orthopedic Surgery: This involves a surgical procedure to lengthen the heel cord (Achilles’
tendon). This is done only in children over the age of 4 to 5 years in whom the other
treatment interventions have been unsuccessful in stretching the Achilles’ tendons.

19. Physical Therapy Intervention :-
>Stretching
>Night splinting
>Therex/Strengthening
>Joint mobilizations
>Balance training (especially standing balance and posterior weight
shifting)
>Gait training/Treadmill training

20. >>MotorControl/MotorLearning
>Strategies
>Taping (if required )
>Orthotics (AFOs or ITW inhibiting)
>Serial casting
>Shoe modifications
>Sensory strategies

21. Dr.Akshay Raj Chandra
(PT)
BPT ,MPT , MIAP ,DCPT
Email :
physio.akshyarajchandra@gmail.com
Phone no :+917827068869

22. THANKYOU