Background: Idiopathic toe walking (ITW) is a diagnosis given to concerned parents of 5-24% of children after the age of three. This diagnosis can be distressing, due to lack of understanding of etiology and effective treatment. Many hypotheses and observations have been proposed as to the cause or triggers of ITW, such as dorsiflexion range of motion (DF ROM) issues, sensory processing issues (SP), poor foot wear during development, motor control impairments, etc. none of which have been proven to be the cause. Many clinicians still seek an effective treatment solution. The purpose of this case study is to report and analyze the most recent, available research on conservative treatment of idiopathic toe walking. Thus giving clinicians ideas, guidelines, and clarity as to how to treat, educate, and support these patients and their families. Case Description: Gavin is a healthy, typically developing, four-year-old boy, except for a persistent toe walking habit. It was found that, in addition to his toe walking tendencies, he was weak in his core and lower extremities, had poor balance, and had sensory seeking behavior. A variety of treatment methods were performed and most goals regarding impairments were met, however he never fully ceased to toe-walk. Methodology: A search of literature concerning ITW was performed with this particular PICO question in mind. 'In children that exhibit idiopathic toe walking after the age of three, is orthotic use in combination with other physical therapy interventions effective in achieving long-term, heel-to-toe gait?' Outcomes: The studies found were based around a variety of conservative treatment methods including orthotics, motor control, augmented feedback, serial casting, dynamic splinting, and stretching. It was found that individual treatments were not as effective as initially hoped, in order to achieve heel-to-toe gait. These treatments, however, did show some improvements. Discussion: The PICO question asked was not answered to the full extent expected by the reviewer. It is proposed that the collaboration of these articles support a hypothesis for the treatment of idiopathic toe walking that was accumulated from the results of these studies.


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Document Type



Advisor: Ron Andrews P.T. Ph.D and Marybeth Barkocy P.T., DPT


Physical Therapy, Idiopathic Toe Walking, Motor Control, Orthotic Devices

Available for download on Monday, March 14, 2118