Walking barefoot on gravel improves gait for children with idiopathic toe walking

Walking barefoot on a gravel surface significantly improved gait in children with idiopathic toe walking, according to research presented here at the American Orthotic & Prosthetic Association National Assembly.

Researcher Mark Geil helps children learn to walk. Center for Pediatric Locomotion Sciences at Georgia State University

by Shawn M. Carter, Healio O&P News September 8, 2014

Mark Geil PhD, director of the Center for Pediatric Locomotion Sciences at Georgia State University, conducted a trial of 15 children with idiopathic toe walking over the course of 6 weeks.

The test was conducted in a gait lab, using a Vicon plug-in gait marker system. The children tested had a mean age of 6.7 years, height of 1.2 meters and body mass of 27.8 kilograms.

Each child performed barefoot walking at a self-selected speed on standard pile carpet; a rounded, unsteady gravel surface; and on the gait lab floor, which served as a smooth surface.

The testing sequence was randomized to attain 10 trials per surface. Researches used the HR32, an outcome measure technique which measures the height of the heel marker at 32% during the gait cycle. Height measurements were relative to each child.

Results revealed a considerable decrease in heel height for the children when walking on the gravel surface. They also showed normal heel rise and heel-to-toe gait and had 100% control over initial contact with the toe.

Findings also showed identical gait patterns compared with a cohort of 15 typically developing children. This is likely because the gravel provided more sensory input and stability, Geil said.

“We did not do this study to come up with a therapy for idiopathic walking, but in the end, this result completely changed our direction,” he said. “This is very good possibility for treating the cause [of idiopathic toe walking] and not just the symptoms.”

Idiopathic toe walking is not caused by cerebral palsy, myopathy, neuropathy or autism, Geil added. There are currently no orthopedic, neurological or psychiatric causes, he said.

He noted that this is an issue that needs intervention because many children with idiopathic toe walking develop contractures, which lead to serial casting or heel cord lengthening surgery.

The Georgia State University team will further explore the role of plantar foot sensation, with a particular focus on orthosis design and implementation of gravel in the foot bed surface. They are currently seeking additional funding from federal agencies to conduct follow-up studies.

Source Healio O&P News

Plantar foot surface ameliorates equinus gait in children with idiopathic toe walking, Mark Geil PhD, Presented at: American Orthotic & Prosthetic Association National Assembly; Sept. 4-7, 2014; Las Vegas NV

The Effects of Walking Surface on the Gait Pattern of Children With Idiopathic Toe Walking, Fanchiang HD, Geil MD, Wu J, Ajisafe T, Chen YP. J Child Neurol. 2016 Jun;31(7):858-63. doi: 10.1177/0883073815624760. Epub 2016 Jan 5.

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