Westberry David E, Davids Jon R, Davis Roy B, de Morais Filho Mauro César
Shriners Hospitals for Children, 950 W Faris Rd, Greenville, SC 29605, USA.
J Pediatr Orthop. 2008 Apr-May;28(3):352-8. doi: 10.1097/BPO.0b013e318168d996.
The differential diagnosis in children who walk on their toes includes mild spastic diplegia and idiopathic toe walking (ITW). A diagnosis of ITW is often one of exclusion. To better characterize the diagnosis of ITW, quantitative gait analysis was utilized in a series of patients with an established diagnosis of ITW.
Patients with an established diagnosis of ITW were analyzed by quantitative gait analysis. Data were recorded as each subject walked in a self-selected toe-walking pattern. The subject was then asked to ambulate making every effort to walk in a normal heel-toe reciprocating fashion. Data were collected to determine if this group of idiopathic toe walkers was able to normalize their gait. Datasets were compared with each other and with historical normal controls.
Fifty-one neurologically normal children (102 extremities) with ITW were studied in the Motion Analysis Laboratory at a mean age of 9.3 years. In the self-selected trials, significant deviations in both kinematics and kinetics at the level of the ankle were identified. Disruption of all 3 ankle rockers and a plantar flexion bias of the ankle throughout the gait cycle were most commonly seen. When asked to attempt a normal heel-toe gait, 17% of the children were able to normalize both stance and swing variables. In addition, 70% were able to normalize some but not all of the stance and swing variables.
Quantitative gait analysis is an effective tool for differentiating mild cerebral palsy from ITW. Kinematic and kinetic distinctions between the diagnoses are evident at the knee and ankle. The ability to normalize on demand at least some of the kinematic and kinetic variables associated with toe walking is seen in most children with ITW.
踮脚尖行走的儿童的鉴别诊断包括轻度痉挛性双侧瘫和特发性踮脚尖行走（ITW）。ITW的诊断通常是排除性诊断之一。为了更好地明确ITW的诊断，对一系列已确诊为ITW的患者进行了定量步态分析。
通过定量步态分析对已确诊为ITW的患者进行分析。在每个受试者以自我选择的踮脚尖行走模式行走时记录数据。然后要求受试者尽力以正常的足跟到足尖交替方式行走。收集数据以确定这组特发性踮脚尖行走者是否能够使他们的步态正常化。将数据集相互比较，并与历史正常对照进行比较。
在运动分析实验室对51名神经功能正常的ITW儿童（102个肢体）进行了研究，平均年龄为9.3岁。在自我选择的试验中，在踝关节水平的运动学和动力学方面均发现了显著偏差。最常见的是在整个步态周期中所有3个踝关节 rocker均被破坏以及踝关节的跖屈偏向。当被要求尝试正常的足跟到足尖步态时，17%的儿童能够使站立和摆动变量均正常化。此外，70%的儿童能够使部分而非全部站立和摆动变量正常化。
定量步态分析是区分轻度脑瘫和ITW的有效工具。在膝关节和踝关节处，这两种诊断在运动学和动力学上的区别很明显。大多数ITW儿童能够根据需要使至少一些与踮脚尖行走相关的运动学和动力学变量正常化。
