Identifying methods for quantifying lower limb changes in children with idiopathic toe walking: A systematic review

Mr Antoni Caserta1,2, Dr  Cylie  Williams2,3, A/Prof Prue Morgan2

1Monash Health, Cranbourne, Australia, 2Monash University , Frankston, Australia, 3Peninsula Health, Frankston, Australia


Idiopathic toe walking (ITW) is a diagnosis of exclusion for children walking on their toes with no medical cause. This systematic review aimed to identify and evaluate the clinical utility, validity and reliability of the outcome measures and tools used to quantify lower limb changes within studies that included children with ITW.

The following databases were searched from inception until March 2018: Ovid MEDLINE, EBESCO, Embase, CINAHL Plus, PubMed. Inclusion criteria were studies including children with ITW diagnosis, reporting use of  measurement tools or methods describing lower limb characteristics, published in peer-reviewed journals, and in English. The relevant psychometric properties of measurement tools were extracted, and assessed for reported reliability and validity. Included articles were assessed for risk of bias using McMaster quality assessment tool. Results were descriptively synthesised and logistic regression used to determine associations between common assessments.

From 3164 retrieved studies, 37 full texts were screened and 27 full texts included. Interventional studies were more likely to report range of motion and gait analysis outcomes, than observational studies. Alvarez classification tool in conjunction with Vicon motion system appeared the contemporary choice for describing ITW gait. There was no significant association between the use of range of motion and gait analysis outcomes and any other outcome tool or assessment in all studies (p>0.05).

This review highlighted that a consensus statement should be considered to guide clinicians and researchers in the choice of the most important outcome measures for this population.


Antoni works both as a private podiatrist and within a public health multidisciplinary paediatric team. His public health role focuses on assessment and treatment of simple and complex gait disorders.

Antoni is the Chair of the Paediatric Special Interest Group for the Australian Podiatry Association (VIC). He has presented numerous times at Australian Podiatry Association Victorian State Conferences, Special Interest Groups. He was the 2014 winner of the Jennifer O’Meara Memorial Award for outstanding achievement for a young podiatrists. He is currently a PhD candidate at Monash University and undertaking research to better understand the lower limb profile of children with an idiopathic toe-walking gait. He is also leading a Cochrane review on the effectiveness of different treatments for normalising idiopathic toe walking gait. Antoni collaborates with Children’s Podiatry, a education and mentoring platform for paediatrics in podiatry.

Antoni enjoys mentoring undergraduate students during their paediatric rotation paediatrics and this has led him to work with Latrobe University to create learning packages specifically relating to assessment.