Multiplanar kinematic deviations in idiopathic toe walking: A comparison with voluntary toe walking gait

INTRODUCTION: Idiopathic toe walking (ITW) refers to persistent toe walking beyond the age of three with no known neuromuscular causes. While ITW is primarily characterised by excessive ankle plantarflexion, multiplanar lower limb and segmental foot kinematic deviations remain underexplored. It is also unclear whether these deviations are merely biomechanical consequences of toe walking or specific to ITW. RESEARCH QUESTION: How does the gait pattern in children with ITW differ from typically developing children during normal walking (TD-N) and voluntary toe walking (TD-TW)? METHODS: This retrospective study included 44 children with ITW, and 44 typically developing children walking in a normal heel-toe pattern as well as voluntarily walking on toes. Three-dimensional lower-limb and multi-segment foot kinematics were collected, and joint kinematics was analysed using one-dimensional statistical parametric mapping adjusted for speed and age. RESULTS: Both toe-walking groups showed reduced step length and velocity, compared to TD-N, while only the TD-TW group walked with reduced step width relative to TD-N. ITW-specific deviations (compared to TD-TW) included excessive ankle plantarflexion at mid-swing, increased knee and hip flexion in swing and external hip rotation. SIGNIFICANCE: Voluntary toe walking does not fully replicate the gait pattern seen in ITW, suggesting the ITW gait pattern represents adaptations beyond biomechanical consequences of walking on toes.