Idiopathic Toe Walking
Conditions
Keywords
idiopathic toe walking, gait disorder, gait analysis, kinesio taping, ultrasound elastography, pediatric, children, muscle stiffness, muscle elasticity
Brief summary
Idiopathic Toe Walking (ITW) is a diagnosis normally of exclusion and likely, consequently, is approached in vastly varying ways of intervention, including serial casting, Botox injections and physical therapy. There is some evidence in the literature that children with ITW can somewhat correct their lack of heel-strike gait pattern at least temporarily. Kinesio Taping (KT) method is an intervention that is used in the outpatient physical therapy setting for various conditions such as post-operative edema, muscle facilitation of weakened rotator cuff muscles, and functional corrections in children with torticollis. This pilot study will strive to determine if KT may be effective by providing proprioceptive and neuromuscular re-education through thermal and mechanical fascial impositions, thereby improving passive joint range of motion (ROM) through reduction of passive muscle stiffness and improving ambulation through neuromuscular re-education in children with idiopathic toe walking. We will quantify passive muscle stiffness of the gastrocnemius and opposing anterior tibialis using non-invasive Shear Wave Elastography (SWE). Further we look at the kinematics and kinetics of the child's ankle during the gait cycle to further determine any effect(s) of KT on functional walking outcome measures. The intent is that the results from this study will serve as a platform from which to expound look at the long-term, if any, effects of KT on the muscle property and gait cycle pattern in children with ITW.
Interventions
DEVICEKinesio Tape of the Ankle
Tibialis anterior facilitation/ gastrocnemius inhibition: Taping to be worn 3-5 days and repeated x 1
Sponsors
Mayo Clinic
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
3 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* Females and males * 3-10 years of age * who independently ambulate * have a diagnosis of idiopathic toe walking
Exclusion criteria
* Children will be excluded if they have a diagnosis of or suspected neuromuscular disorder * had prior treatment for ITW including bracing or including splinting in the last six months, chemodenervation, serial casting in the last six months, surgical intervention * diagnosis of Autism or Pervasive Developmental Disorder * history of allergic reactions to tape/adhesives.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Ankle Joint Range of Motion | At enrollment, one and two week after kinesio taping | To evaluate effect of KT on passive ankle ROM, we will measure passive ankle ROM before and after treatment. With the child laying prone, measurements of ankle ROM will be taken using a goniometer with the knee extended and with the knee flexed at 90 degrees. The rationale for this is to differentiate gastrocnemius muscle from soleus muscle, with gastrocnemius contributing to ankle ROM loss when knee is extended because it crosses both joints. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Advanced gait analysis - Change in kinetics | At enrollment, after completion of taping (2-3 weeks after enrollment) | In children with ITW, gait changes, as measured by ankle kinetics and kinematics, have been shown as toe-walking improves. In ITW, presence of a first ankle rocker, presence of an early third ankle rocker, and predominant early ankle moment on advanced gait analysis are used to classify idiopathic toe walking into three severity groups. Changes to these parameters are used to evaluate effect of treatment on ITW. Therefore, we propose to use these parameters to classify the severity of the ITW before and after KT treatment to evaluate effect of KT on ambulation. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Supersonic Shearwave Ultrasound Elastography: Change in muscle elasticity | At enrollment, upon completion of taping (2-3 weeks after enrollment) | Currently, there is indirect evidence that children with ITW have increased passive stiffness of the gastrocnemius muscle, and no evidence with regard to passive stiffness of the anterior tibialis, a major ankle plantar flexion antagonist. Abnormal passive stiffness of these muscles is thought to result in the loss of passive ROM and changes to ambulation. However, direct measurements of passive muscles stiffness in children have not been able to be done, until recently. Therefore, we propose to quantify the passive muscle stiffness of the gastrocnemius muscle and anterior tibialis muscle in children with ITW before and after KT treatment using SWE. |
Countries
United States
Outcome results
None listed