An Interesting Study on Toe Walking
As OTs (and certainly our pediatric PT colleagues) we have all seen our share of kids that are toe walking with no history of any apparent medical disorder that would account for the problem such as CP or sequelae from a TBI. Termed Idiopathic Toe Walking (ITW) it seems there is some emerging research that suggests what many therapists have surmised anecdotally over the years: that some children with SPD issues (sensory defensiveness) exhibit this abnormal gait pattern. After completing an extensive literature review on ITW, an Australian podiatrist Cylie Williams and her colleagues conducted a study comparing 30 normal healthy children ages 4-8 with 30 children identified with ITW. "They measured the children's vibration perception threshold (VPT) in the right hallux using a vibratory sensory analyzer that delivers a frequency vibration of 100 Hz (amplitude range, 0-130 µm) through a Teflon-coated pin mounted in a footplate." "The vibration mimics the everyday tactile input that allows the brain to sense fine surface texture changes, which, in the feet, play a key role in protection and proprioception." The results? The children with ITW had a significantly lower vibration perception threshold than the control group. You can read a review of the research from the Lower Extremity Review. Most of the treatment discussion focuses on more medical interventions such as AFO's, night splints, Botox ® injections) but given the research findings don't you think our OT interventions (such as the Wilbarger Protocol, sensory play incorporating a variety of tactile and proprioceptive input etc.) that we have long used would seem to have validity as well in addressing ITW issues? Williams concludes that more studies are needed but that the takeaway from this work "... is a need for healthcare providers to consider the whole child rather than their gait pattern alone." As OTs we can all agree on that!