Transcript Differentiation between idiopathic toe

 Definitions:
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Idiopathic (cause unknown) toe walking
Toe-walking at mild diplegia (cerebral
palsy)
gait analysis
Random forest
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What is toe-walking?
Toe-walking is failure of
the heel to make contact
with the floor at the onset
of stance or absence of a
heel strike.
i.e. toe-walking is walking
on the toes OR on the ball
of foot
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Cerebral palsy (most common cause)
Duchenne muscular dystrophy
Myopathy
Neuropathy
Spinal dysraphism
Developmental disorders (ex/ autism)
Idiopathic toe walking (diagnosis of
exclusion)
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Toe-walking without any neurological
problems
Toddlers (after age of 3 => habitual toe
walking)
Toe walking with coordinated work of muscles
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Studies have noted a positive family history
of toe walking in children with ITW with a
reported incidence of between 10 and 88 %
(Fox 2006 ).
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Congenital short tendo calcaneus (achilles
tendon)
Limitations in passive ankle dorsiflexion
Neurologically: muscle tone, deep tendon
reflexes, muscle strength, and sensation are
normal
Children ambulate independently on
bilateral toes at a normal age and walk on
their toes from initiation of independent
walking
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Toe-walking without a decrease in range of
joint motion of the ankle joint is reported to
be present in children with autism, in children
with communication (language) disorders and
learning disabilities, as well as in children
with fine motor, visuomotor- and gross
motor delays
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Cerebral palsy
Autism
Other developmental disorders
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Toe walking
Other symptoms may be speech delay,
seizures, poor coordination, etc.
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Armand, et al carried out 2511 gait analyses in 1736 patients with 11950
trials.4 The authors established three equines gait patterns based on ankle
kinematics during stance phase:
• G1 – A long progressive dorsiflexion followed by plantar flexion until toe
off. This pattern was more prevalent in old equinovarus feet, myopathies and
neuropathies.
• G2 – Short lived dorsiflexion with progressive plantar flexion until toe off.
This pattern was most common in ITW patients (up to 44% of all in the
series).
• G3 – Double bump pattern, short lived dorsiflexion, short lived plantar
flexion and plantar flexion until toe off (cerebral palsy pattern).
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Variable heel strike
Reversal of second rocker
Early firing of the soleus by EMG evaluation
Silence of the gastrocnemius muscle in the
swing phase
Normal anterior tibial function by EMG.
Premature ankle plantar flexion during the
second rocker.
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Kinematics
◦ Persistent PF
◦ Knee extension in stance
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Kinetics
◦ Double bump pattern
◦ Loss of ankle dorsiflexion
moment in initial stance
◦ Knee flexion moment in
stance