Toe Walking Workup

  • Author: Edwards P Schwentker, MD; Chief Editor: Jason H Calhoun, MD, FACS   more...
 
Updated: Feb 17, 2012
 

Imaging Studies

  • Radiographs of the spine
    • In a patient with muscle spasticity that is not secondary to cerebral palsy or in a patient with isolated lower extremity weakness, anteroposterior (AP) and lateral radiographs of the thoracolumbar spine are indicated.
    • The images should be examined for bifid defects and the widening of the distance between pedicles that might attend an intraspinal anomaly.
  • Magnetic resonance imaging (MRI) of the spinal cord - If the plain radiographic findings are positive or if suspicion is otherwise high, a magnetic resonance image of the spinal cord should be obtained to further evaluate the possibility of an intraspinal anomaly as a cause for spasticity.
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Other Tests

  • Gait analysis
    • If it is available, a formal gait analysis in a patient with muscle spasticity may be helpful in the preoperative evaluation of toe walking.
    • Dynamic electromyographic data can be obtained from surface or intramuscular electrodes to time muscle activity to the phases of the gait cycle.
    • Quite sophisticated techniques for motion analysis are available as well.[6, 7]
    • Formal gait labs are not universally available, and the value of the information they provide still is controversial. They are of limited use in the evaluation of idiopathic toe walkers and patients with paralytic muscle disease.
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Contributor Information and Disclosures
Author

Edwards P Schwentker, MD  Professor, Departments of Orthopedics and Rehabilitation and Pediatrics, Pennsylvania State College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

John S Early, MD  Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship, Baylor University Medical Center

John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, and Texas Medical Association

Disclosure: AO North America Honoraria Speaking and teaching; Osteotech Consulting fee Consulting; Stryker Consulting fee Consulting; Biomet Consulting fee Consulting; AO North America Grant/research funds fellowship funding; MMI inc Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Shepard R Hurwitz, MD  Executive Director, American Board of Orthopaedic Surgery

Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS  Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

References

  1. Solan MC, Kohls-Gatzoulis J, Stephens MM. Idiopathic toe walking and contractures of the triceps surae. Foot Ankle Clin. Jun 2010;15(2):297-307. [Medline].

  2. Engelbert R, Gorter JW, Uiterwaal C, van de Putte E, Helders P. Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness?. BMC Musculoskelet Disord. Mar 21 2011;12:61. [Medline]. [Full Text].

  3. Neptune RR, Burnfield JM, Mulroy SJ. The neuromuscular demands of toe walking: a forward dynamics simulation analysis. J Biomech. 2007;40(6):1293-300. [Medline].

  4. Sasaki K, Neptune RR, Burnfield JM, et al. Muscle compensatory mechanisms during able-bodied toe walking. Gait Posture. Jul 9 2007;[Medline].

  5. Westberry DE, Davids JR, Davis RB, de Morais Filho MC. Idiopathic toe walking: a kinematic and kinetic profile. J Pediatr Orthop. Apr-May 2008;28(3):352-8. [Medline].

  6. Armand S, Watelain E, Mercier M, et al. Identification and classification of toe-walkers based on ankle kinematics, using a data-mining method. Gait Posture. Feb 2006;23(2):240-8. [Medline].

  7. Pendharkar G, Percival P, Morgan D, Lai D. Automated method to distinguish toe walking strides from normal strides in the gait of idiopathic toe walking children from heel accelerometry data. Gait Posture. Jan 31 2012;[Medline].

  8. Katz MM, Mubarak SJ. Hereditary tendo Achillis contractures. J Pediatr Orthop. Nov 1984;4(6):711-4. [Medline].

  9. 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. Dec 2006;72(6):722-30. [Medline].

  10. Hall JE, Salter RB, Bhalla SK. Congenital short tendo calcaneus. J Bone Joint Surg Br. Nov 1967;49(4):695-7. [Medline]. [Full Text].

  11. McMulkin ML, Baird GO, Caskey PM, Ferguson RL. Comprehensive outcomes of surgically treated idiopathic toe walkers. J Pediatr Orthop. Sep-Oct 2006;26(5):606-11. [Medline].

  12. Hemo Y, Macdessi SJ, Pierce RA, et al. Outcome of patients after Achilles tendon lengthening for treatment of idiopathic toe walking. J Pediatr Orthop. May-Jun 2006;26(3):336-40. [Medline].

  13. Green NE. The orthopaedic management of the ankle, foot, and knee in patients with cerebral palsy. Instr Course Lect. 1987;36:253-65. [Medline].

  14. Rosenthal RK. The use of orthotics in foot and ankle problems in cerebral palsy. Foot Ankle. Jan-Feb 1984;4(4):195-200. [Medline].

  15. Williams EA, Read L, Ellis A, et al. The management of equinus deformity in Duchenne muscular dystrophy. J Bone Joint Surg Br. Aug 1984;66(4):546-50. [Medline]. [Full Text].

 
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An articulated molded ankle-foot orthosis (MAFO); this cosmetic appliance fits into a regular shoe. It allows free dorsiflexion but prevents plantarflexion and hence, toe walking.
 
 
 
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