Background: Approximately 5% of 6-year-old children demonstrate idiopathic toe walking (ITW). In addition to gait changes, children with ITW demonstrate limitations in balance and function.1,2 Currently, there are no interventions for ITW harnessing feedback during rehearsal of a heel strike in the natural environment. Method: Fourteen participants (mean age= 10.3 years (SD 2.9), 10M/4F) diagnosed with ITW were evaluated prior to intervention (W0), following 12 weeks of intervention (W12) and 10 weeks-post intervention (P10) on parent report of toe walking (TW%), maximum dorsiflexion range (maxDF), sensory organization test (SOT), and 3D gait analysis during typical walking. During a 12-week intervention phase, each child used a smart system which included a shoe insert with a haptic vibrator providing immediate feedback after toe strikes and a phone App which provided summary feedback for the user and parent on toe versus heel steps. A mixed effects linear model was used for analysis. Results: Thirteen of 14 participants utilized the system for a mean of 229,491 steps (range 107,041-396,967 steps) over 57 mean days (range 30-81 days). One participant used the inserts 3 days (6851 steps) secondary to limitations in shoe fit. Data from all 14 participants were included in the analysis. Parents reported % toe walking significantly decreased (p<.001) from 72.7% at W0, to 47.0% at W12, and down to 30.8% at P10. MaxDF demonstrated a significant increase (p=0.004) from 7.4 at W0 to 9.4 at W12. SOT total scores demonstrated a non-significant increase (p=0.11) from 51.3 at W0, to 54.8 at W12, and 56.4 at P10. Significant differences were observed in the gait analysis between measurements at W0 and W12 with no significant difference between W12 and P10, including an increase in toe clearance (p<0.001), increased ankle dorsiflexion at heel strike (p=0.006), increased dorsiflexion during swing (p=0.005), and an increase in height of the lateral 5th metatarsal marker compared to the heel marker (p=.009). No significant differences were found in stride length, stride time or percent stance over the 3 measurement times. Discussion: These results suggest that a 12-week intervention with a smart system providing immediate and summary feedback in the natural environment has potential to retrain the ankle motion during gait in children with ITW. These results are strengthened by the fact that significant differences were observed in measurements at the ankle with no other changes in gait characteristics. In addition, an examination of the participant who had difficulty with shoe fit, demonstrated no improvements in ankle measurements over the 12-week intervention period. Our work demonstrates initial success in improving gait through use of a smart insole among children diagnosed with ITW. While this work is encouraging, additional development of this smart system and a larger clinical trial is needed. Subject: Idiopathic Toe Walking, Gait, Children, Intervention
