The differential diagnostic of Idiopathic Toe Walking
Main Article Content
Abstract
Idiopathic toe walking (ITW) is the persistence of the tip-toe walking pattern after two years of age. The diagnosis is made by ruling out any neurological or orthopedic condition which causes this walking anomaly. There are other medical conditions in which the weight bearing occurs on the forefoot which can lead to misdiagnosis and misguided treatment. The main goal of this publication is to provide a concise review of idiopathic toe walking and its classification according to clinical characteristics found among children with a tip-toe walking pattern. In addition, we will point out some physical characteristics that may help to differentiate toe walking from other medical conditions in which the gait pattern occurs on the forefoot as well. Typical conditions which are commonly known to cause a pathological forefoot gait, like autism and tethered cord are intentionally excluded from this article. This review highlights the importance of the observation of the foot features, gastrocnemius shape and gait analysis during the clinical examination to distinguish idiopathic toe walking from other conditions.
Article Details
How to Cite
POMARINO, David; MARTIN, Stephan; POMARINO, Andrea.
The differential diagnostic of Idiopathic Toe Walking.
Medical Research Archives, [S.l.], v. 5, n. Issue 9, sep. 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1504>. Date accessed: 21 dec. 2024.
Keywords
Idiopathic Toe Walking, ITW, Pomarino, Classification of ITW
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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9. Hall J.E, Salter R.B, Bhalla S.K. Congenital Short Tendo Calcaneus. Vol 49 No 4, November 1967.
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16. Menotti F, Laudani L, Antonalle D, Mignogna T, Macaluso A. An anterios ankle-foot orthosis improves walking economy in Charcot-Marie-Tooth type IA patients. Prosthetics and Orthotics International. 2014. Vol 38 (5) 387-392
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19. Casanovas C, Cano LM, Albeti A, Cespedes M, Rigo G. Charcot-Marie-Tooth Disease. Foot & Ankle Specialist. 2008; Vol. 1 no. 6:350-354
20. Chitra Sankar and Nandini Mundkur. Cerebral Palsy-Definition, Classification, Etiology and Early Diagnosis. Indian Journal of Pediatrics. 2005, Vol 72 Oct.
21. Gage JR. Gait Analysis in Cerebral Palsy. London: Mac Keith Press
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24. Katharina Bushby, Richard Finkel, David Birkrant, Laura E Case, Paula R Clemens, Linda Cripe, Ajay Kaul, Kathi Kinnett, Craig McDonald, Shree Pandya, James Poysky, Frederic Shapiro, Jean Tomezsko, Carolyn Constatin. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management. 2009 Nov 30.
25. D’Angole MG, Berti M, Piccini L, Romei M, Guglieri M, Bonato S, Degrate A, Turconi AC, Bresolin N. Gait Pattern in Duchenne muscular dystrophy. Gait and posture. 2009; 29 (1):36-41
26. Eppie M Yiu, Andrew J Kornberg. Duchenne muscular dystrophy. Neurology India. 2008, July-Sep, Vol 56. Issue 3.
27. Siegel KL, Kepple TM, Stanhope SJ. A case study of a case compensation for hip muscle weakness in idiopathic inflammatory myopathy. Clinical Biomechanics. 2007; 22 (3): 319-326
28. Vissing J, Ronald GH: The Effect of Oral Sucrose on Exercise Tolerance in Patients with McArdle’s Disease. The New England Journal of Medicine, 2016, 349;26
29. Siciliani Scalco R., Chatfield S., Godfrey R.,Pattni J., Ellerton C., Beggs A., Brady S., Wakelin A., Holton J., Quinlivan R. From exercise intolerance to functional improvement: the second wind phenomenon in the identification of Mc Ardle disease. JLH 2014
30. Bollig G. McArdle’s disease (glycogen storage disease type V) and anesthesia – case report and review of the literature. Pediatric Anesthesia 2013; 23: 817-823
31. Diez Morrondo C., Pantoja Zarza L., San Millán Tejado B. Enfermedad de Mc Ardle: presentación de 2 casos clínicos. Reumatología Clínica 2015.
32. Bartram C., Edwards R., Beynon R. McArdle’s disease-muscle glycogen phosphorylase deficiency. Biochimica et Biophysica Acta 1995; 1-13
33. Pomarino D, Ramirez-Llamas J, Pomarino A. Caso Clínico: Falso diagnóstico de caminador en puntillas de pies; sospecha de enfermedad de McArdle (Case Study: Fake diagnosis of Idiopathic Toe Walker (ITW); suspicion of McArdle disease). Revista Chilena de Ortopedia y Traumatología. 2016 (in print)
34. http://gesundpedia.de/Morbus_Pomarino
35. D. Pomarino. M. Klawonn, S. Stock, L. Zörnig, S. Martin, A. Pomarino: „Stufentherapie des habituellen Zehenspitzenganges“. Orthopäd. Praxis 04/ 10 S. 161 – 168
36. D. Pomarino. Ramirez Llamas, J., A. Pomarino: “Idiopathic Toe Walking: Tests and Family Predisposition”. PubMed. gov, 2016 Feb 12. US National Library of Medicine – National Institutes of Health
37. D. Pomarino, N. Veelken, S. Martin: “ Der habituelle Zehenspitzengang – Diagnostik, Klassifikation, Therapie”. 2012 Schattauer GmbH
2. Huntsman R, Lemire E, Norton J, Dzus A, Blackey P, Hasal S. The differential diagnosis of spastic diplegia. Arch Dis Child 2015: 500-504.
3. Williams CM, Tinley P, Curtin M. Idiopathic toe walking and sensory processing dysfunction. Journal of Foot and Ankle Research 2010, 3:16
4. Pomarino D, Ramirez-Llamas J, Pomarino A. Idiopathic Toe Walking: Family Predisposition and Gender Distribution. Foot & Ankle Specialist. 2016 (In print)
5. Striker SJ, Angulo JC. Idipathic toe walking: a comparison of treatment methods. J Pediatr Orthop. 1998; 18 (3): 289-293
6. Fox A. Deakin S, Pettigrew G, Paton R. Serial casting in the treatment of idiopathic toe-walkers and review of the literature. Acta Orthop Belg. 2006;72 (6):722-730
7. Engström P, Gutierrez-Farewik EM, Bartonek A, Tendroff K, Orefelt C, Haglund-Akerlind Y. Does botulinum toxin A improve the walking pattern in children with idiopathic toe walking? . J Child Orthop. 2010; 4 (4); 301-308
8. Engström P, Tedroff K. The prevalence and course of Idiopathic toe walking in 5-Years-Old children. 2012.
9. Hall J.E, Salter R.B, Bhalla S.K. Congenital Short Tendo Calcaneus. Vol 49 No 4, November 1967.
10. Huntsman R., Lemire E., Norton J., Dzus A., Blakley P., Hasal S. The differential diagnosis of spastic diplegia. Arch Dis Child 2015; 100:500-504
11. Pomarino D, Klawonn M, Stock S, Zornig L, Martin S, Pomarino A. Stufentherapie des habituellen Zehenspitzenganges. Orthopädische Praxis 46, 4, 2010.
12. Pomarino D, Ramirez-Llamas J, Martin S, Pomarino A. The 3-step Pyramid Insole Treatment Concept for Idiopathic Toe Walkers. Foot & Ankle Specialist. 2016 Sep.
13. Pomarino D, Zornog L, Meincke P, Rubtsova I. Klassification des habituellen Zehenspitzengang. Neuropadiatrie in Klinik und Praxis 04/2011 S. 120-123
14. Furrer F, Deonna T. Persistent toe-walking in children. A comprehensive clinical study of 28 cases. Helv Paediatr Acta 1982; 37:301-16
15. B. Schlotter-Weigel, A. Abicht, H. Lochmüller. Hereditäre sensomotorische Neuropathien im Kindes- und Jugendalter. Neuropädiatrie in Klinik und Praxis. 2007, Nr 03.
16. Menotti F, Laudani L, Antonalle D, Mignogna T, Macaluso A. An anterios ankle-foot orthosis improves walking economy in Charcot-Marie-Tooth type IA patients. Prosthetics and Orthotics International. 2014. Vol 38 (5) 387-392
17. Vincenzo Lupo, PhD, Samuel I. Pascual-Pascual, MD, PhD, Paula Sancho, MSc, Eduardo Calpena MSc, Manuel Gutierrez-Molina, MD, Gonzalo Mateo-Martinez MD, Carmen Espinos PhD, Gema Arriola Pereda MD, PhD. Complexity of the Hereditary Motor and Sensory Neuropathies: Clinical and Cellular Characterization of the MPZ p.D90E Mutation. J of Child Neurology. 2015, Vol 30 (11) 1544-1548
18. Agnes Jani-Acsadi, M.D, Karen Krajewski, M.S., and Michael E. Shy, M.D. Charcot-Marie-Tooth Neuropathies: Diagnosis and Managment. Seminar in Neurology. 2008, Vol 28, Num 2.
19. Casanovas C, Cano LM, Albeti A, Cespedes M, Rigo G. Charcot-Marie-Tooth Disease. Foot & Ankle Specialist. 2008; Vol. 1 no. 6:350-354
20. Chitra Sankar and Nandini Mundkur. Cerebral Palsy-Definition, Classification, Etiology and Early Diagnosis. Indian Journal of Pediatrics. 2005, Vol 72 Oct.
21. Gage JR. Gait Analysis in Cerebral Palsy. London: Mac Keith Press
22. Wren TA, Rethlfsen S & Kay RM. Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. Jurnal of Pediatric Orthopaedics; 25 (1): 79-83
23. Woolley S. Characteristics of Gait in Hemiplegia. Topics in Stroke Rehabilitation. 2001; 7 (4):1-18.
24. Katharina Bushby, Richard Finkel, David Birkrant, Laura E Case, Paula R Clemens, Linda Cripe, Ajay Kaul, Kathi Kinnett, Craig McDonald, Shree Pandya, James Poysky, Frederic Shapiro, Jean Tomezsko, Carolyn Constatin. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management. 2009 Nov 30.
25. D’Angole MG, Berti M, Piccini L, Romei M, Guglieri M, Bonato S, Degrate A, Turconi AC, Bresolin N. Gait Pattern in Duchenne muscular dystrophy. Gait and posture. 2009; 29 (1):36-41
26. Eppie M Yiu, Andrew J Kornberg. Duchenne muscular dystrophy. Neurology India. 2008, July-Sep, Vol 56. Issue 3.
27. Siegel KL, Kepple TM, Stanhope SJ. A case study of a case compensation for hip muscle weakness in idiopathic inflammatory myopathy. Clinical Biomechanics. 2007; 22 (3): 319-326
28. Vissing J, Ronald GH: The Effect of Oral Sucrose on Exercise Tolerance in Patients with McArdle’s Disease. The New England Journal of Medicine, 2016, 349;26
29. Siciliani Scalco R., Chatfield S., Godfrey R.,Pattni J., Ellerton C., Beggs A., Brady S., Wakelin A., Holton J., Quinlivan R. From exercise intolerance to functional improvement: the second wind phenomenon in the identification of Mc Ardle disease. JLH 2014
30. Bollig G. McArdle’s disease (glycogen storage disease type V) and anesthesia – case report and review of the literature. Pediatric Anesthesia 2013; 23: 817-823
31. Diez Morrondo C., Pantoja Zarza L., San Millán Tejado B. Enfermedad de Mc Ardle: presentación de 2 casos clínicos. Reumatología Clínica 2015.
32. Bartram C., Edwards R., Beynon R. McArdle’s disease-muscle glycogen phosphorylase deficiency. Biochimica et Biophysica Acta 1995; 1-13
33. Pomarino D, Ramirez-Llamas J, Pomarino A. Caso Clínico: Falso diagnóstico de caminador en puntillas de pies; sospecha de enfermedad de McArdle (Case Study: Fake diagnosis of Idiopathic Toe Walker (ITW); suspicion of McArdle disease). Revista Chilena de Ortopedia y Traumatología. 2016 (in print)
34. http://gesundpedia.de/Morbus_Pomarino
35. D. Pomarino. M. Klawonn, S. Stock, L. Zörnig, S. Martin, A. Pomarino: „Stufentherapie des habituellen Zehenspitzenganges“. Orthopäd. Praxis 04/ 10 S. 161 – 168
36. D. Pomarino. Ramirez Llamas, J., A. Pomarino: “Idiopathic Toe Walking: Tests and Family Predisposition”. PubMed. gov, 2016 Feb 12. US National Library of Medicine – National Institutes of Health
37. D. Pomarino, N. Veelken, S. Martin: “ Der habituelle Zehenspitzengang – Diagnostik, Klassifikation, Therapie”. 2012 Schattauer GmbH