Paediatric Toe-Walking: Causes and consequences
Research type
Research Study
Full title
Paediatric Toe-Walking: Causes and consequences for children with cerebral palsy and idiopathic toe-walkers
IRAS ID
245497
Contact name
Thomas O'Brien
Contact email
Duration of Study in the UK
2 years, 0 months, 31 days
Research summary
When children first learn to walk, they do so by walking on their toes. Some children do not grow out of this, with 3-5 new cases of toe-walking presenting at Alder Hey each week. Continued toe-walking can cause pain, functional impairments, reduced walking endurance, and a reduced quality of life (Ruzbarsky, Curr Opin Pediat, 2016).
Toe-walking commonly presents in children with cerebral palsy (CP; the most common cause of physical disability amongst children (Oskoui, Dev Med Child Neurol, 2013)), because spasticity and contracture pull the ankle into plantarflexion (Gage, 2009). The balance of levers at the ankle (mechanical advantage) is also altered in children with CP (Kalkman, J Biomech, 2017). This may contribute to toe-walking, but it has not yet been investigated. Even within a population as clinically well-defined as CP, how these alterations lead to toe-walking are not well understood. As a result, diagnosis and treatment are often not well informed.
A second group of children who toe-walk are idiopathic toe-walkers (ITW); a term used when no underlying pathological, orthopaedic or neurological cause can be identified (Speedtsberg, Gait Posture, 2017). ITW either receive no specific treatment (current practice at Alder Hey) or receive orthopaedic treatments (casting/surgery) that are invasive, often do not normalise gait, can cause weakness, and have an unpredictable medium and long term outcome with high rates of recurrence (Pomarino, Foot Ankle Spec, 2016).
We hypothesise that children may toe-walk because of (1) a restricted range of motion, (2) spasticity, (3) muscle weakness, or (4) poor joint leverage. We will integrate ultrasound imaging and motion analysis to provide novel insight into the neuro-musculoskeletal alterations that contribute to physical disability in children. We will investigate the direct links between muscle properties and specific gait characteristics, and assess the consequences of toe-walking on stability and walking economy.
REC name
North West - Liverpool Central Research Ethics Committee
REC reference
18/NW/0526
Date of REC Opinion
3 Oct 2018
REC opinion
Further Information Favourable Opinion