Postural Analysis of Idiopathic Toe Walking in Children: A Systematic Review

Abstract

Background: Approximately 5% of children aged 5 to 15, regardless of gender, are diagnosed with Idiopathic Toe Walking without a medical cause, when the condition persists for more than six months. These Children often display coordination issues and biomechanical disturbances during dynamic movements. Kinetic, kinematic and electromyography data are crucial for understanding these adaptations to clarify the neurophysiological processes that regulate posture. Authors have also developed classifications based on clinical, morphological, or kinematic parameters.

Objective: This systematic review aims to analyze postural adaptation in children with Idiopathic Toe Walking by examining kinetic and kinematic parameters, as well as muscle activity. Method: Articles were selected following PRISMA guidelines, considering relevance to the research question and methodological quality. A comprehensive search strategy was employed across four databases. Article screening and data extraction were independently conducted by two reviewers to ensure methodological rigor. The methodological quality of the trials was assessed in using the Newcastle-Ottawa Quality Scale.

Results: The searches yielded a total of 681 results, and 6 articles were included in this systematic review. Electromyographic analyses revealed atypical muscle activation patterns in children with idiopathic toe walking, including premature gastrocnemius activity during swing phase and increased coactivation during resisted tasks, indicating altered neuromuscular control. Kinematic assessments identified reduced passive ankle dorsiflexion and early heel rise, quantified by a specific index (HR32), reflecting impaired gait stability. Kinetic findings showed increased plantar flexion moments and early-phase ankle power absorption, highlighting biomechanical adaptations consistent with equinus gait.

Discussion: Measured activations of gastrocnemius and soleus during Idiopathic Toe Walking could be interpreted as dictated by equinus biomechanics rather than by pathology alone. The kinetic and kinematic approach allows practitioners to understand postural compensations related to equinus in Idiopathic Toe Walking and determine classifications and treatments based on ankle movements and force moments.

Conclusion: These results emphasize the importance of early physiotherapeutic intervention before the age of six to address postural adjustments in relation to the child’s ontogenetic motor development. Descriptions of lower limb muscle activity in this gait help physiotherapists determine exercise intensity to manage muscle fatigue