Taming Idiopathic Toe Walking: Examining the Toe Tamer® for Children Who Idiopathically Toe-Walk

Idiopathic toe-walking (ITW) is the abnormal continuance of toe-walking after the age of two-years that affects five-percent of children in the United States. The behavior has significant physical implications that affect a child’s occupational engagement. Physicians often refer children who toe-walk to OTs to address the regularly-coinciding sensory impairments and occupational performance needs of children who toe-walk. An OTR/L, developed the Toe Tamer® (TT) protocol in response to the needs of students with ITW in school system and clinic practice. A TTR is a stack of weighted washers based on the child’s weight, wrapped in duct tape and secured to a pair of sneakers with a rubber band over the dorsum of the foot and at the ankle, one TTR per sneaker. The recommended wear-time is three to four-hours daily, five to seven-days of the week. The OT developed a TTR manual outlining evaluation parameters, construction of, and wearing protocol. Although she has generated extensive anecdotal experience on the effectiveness of the TTR protocol, it has not yet been rigorously tested. This research is relevant to the practice of OT for providing an individualized, accessible, cost effective solution to ameliorate the effects of idiopathic toe walking in some children. This was a quasi-experimental, one-group pretest-posttest study to answer the following question: Does the Toe Tamer protocol have a significant effect on decreasing the heel-to-floor distance of children 4-7 y/o who idiopathically toe-walk? Researchers measured if the TTR protocol has an effect on the heel-to-floor distance when walking in children with ITW. Inclusion criteria involved participants between 4-7 y/o; toe-walk for 12 or more waking hours of the day; agree to only using the TTR device for the duration of the TTR trial, excluding any other devices worn to decrease toe-walking; exhibit a potential sensory processing impairment per the Sensory Processing Measure (SPM) preschool (2-5 years old) or home form (5-12 years old); not have orthopedic or neurologic deficits, such as cerebral palsy or muscular dystrophy cause for toe-walking behaviors. Due to this specific inclusion criteria, researchers utilized snowball sampling beginning with local therapy clinics. Due to COVID-19 restrictions, recruiting, the consenting process, and implementation of this research was undertaken with the participant under the supervision of his caregiver. The TTR protocol included taking of measurements by his caregiver under the direct instruction of researchers using GoogleMeet video conferencing. Pretest measurements of heel-to-floor distance for each foot while toe-walking were taken at the beginning of the first week. The child wore the TTR three to four hours per day, five to seven days per week for six weeks. Post test measurements of heel-to-floor distance for each foot will be taken at the end of the six weeks. Pretest and posttest measurements will be compared with two Wilcoxon Signed-Rank tests—one for right-foot pre- and post test heel-to-floor distance measurements, one for left-foot pre- and posttest heel-to-floor distance measurements. Researchers chose a non parametric analysis because of the small sample size, which prevents the use of a parametric test such as the Paired T-test. This research is currently in progress. A four-year-old participant’s baseline heel-to-floor measurement was 3.5 inches. After one week, the caregiver reported that the child would not comply with wearing protocol, necessitating changing the type of tennis shoe worn to one with a higher ankle support. This study anticipates providing evidence for the utility of a noninvasive, cost-effective, accessible intervention to mitigate detrimental effects of toe-walking in children.

References

McCaigue, I.S. (2017). Taming Idiopathic Toe Walking: A Treatment Guide for Parents and Therapists. Suwanee, GA: Handy O.T. Treatment Tools, LLC.

Chu, V. (2018). Quantifying sensory function associated with idiopathic toe walking in children. American Journal of Occupational Therapy, 72, 7211500035. https://doi.org/10.5014/ajot.2018.72S1-PO4043

Engström, P., & Tedroff, K. (2018). Idiopathic toe-walking: Prevalence and natural history from birth to ten years of age. The Journal of Bone and Joint Surgery, 100(8), 640–647. https://doi.org/10.2106/JBJS.17.00851

Morozova, O. M., Chang, T. F., & Brown, M. E. (2017). Toe walking: When do we need to worry? Current Problems in Pediatric and Adolescent Health Care, 47(7), 156-160. https://doi.org/10.1016/j.cppeds.2017.06.004