Alvarez Christine, De Vera Mary, Beauchamp Richard, Ward Valerie, Black Alec
UBC, Faculty of Medicine, Department of Orthopaedics, BC Children's Hospital, A203-4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
Gait Posture. 2007 Sep;26(3):428-35. doi: 10.1016/j.gaitpost.2006.10.011. Epub 2006 Dec 11.
Idiopathic toe walking (ITW), considered abnormal after the age of 3 years, is a common complaint seen by medical professionals, especially orthopaedic surgeons and physiotherapists. A classification for idiopathic toe walking would be helpful to better understand the condition, delineate true idiopathic toe walkers from patients with other conditions, and allow for assignment of a severity gradation, thereby directing management of ITW. The purpose of this study was to describe idiopathic toe walking and develop a toe walking classification scheme in a large sample of children. Three primary criteria, presence of a first ankle rocker, presence of an early third ankle rocker, and predominant early ankle moment, were used to classify idiopathic toe walking into three severity groups: Type 1 mild; Type 2 moderate; and Type 3 severe. Supporting data, based on ankle range of motion, sagittal joint powers, knee kinematics, and EMG data were also analyzed. Prospectively collected gait analysis data of 133 children (266 feet) with idiopathic toe walking were analyzed. Subjects' age range was from 4.19 to 15.96 years with a mean age of 8.80 years. Pooling right and left foot data, 40 feet were classified as Type 1, 129 were classified as Type 2, and 90 were classified as Type 3. Seven feet were unclassifiable. Statistical analysis of continuous variables comprising the primary criteria showed that the toe walking severity classification was able to differentiate between three levels of toe walking severity. This classification allowed for the quantitative description of the idiopathic toe walking pattern as well as the delineation of three distinct types of ITW patients (mild, moderate, and severe).
特发性足尖行走（ITW）在3岁以后被视为异常，是医学专业人员，尤其是骨科医生和物理治疗师常见的就诊问题。特发性足尖行走的分类有助于更好地理解这种病症，将真正的特发性足尖行走者与患有其他病症的患者区分开来，并进行严重程度分级，从而指导ITW的治疗。本研究的目的是描述特发性足尖行走，并在大量儿童样本中制定足尖行走分类方案。使用三个主要标准，即是否存在第一个踝关节摆动、是否存在早期第三个踝关节摆动以及主要的早期踝关节力矩，将特发性足尖行走分为三个严重程度组：1型轻度；2型中度；3型重度。还分析了基于踝关节活动范围、矢状面关节力量、膝关节运动学和肌电图数据的支持性数据。对前瞻性收集的133名患有特发性足尖行走儿童（266只脚）的步态分析数据进行了分析。受试者年龄范围为4.19至15.96岁，平均年龄为8.80岁。将左右脚数据合并后，40只脚被分类为1型，129只被分类为2型，90只被分类为3型。7只脚无法分类。对构成主要标准的连续变量进行的统计分析表明，足尖行走严重程度分类能够区分三个级别的足尖行走严重程度。这种分类能够对特发性足尖行走模式进行定量描述，并区分三种不同类型的ITW患者（轻度、中度和重度）。
