O'Sullivan Rory, Munir Khalid, Keating Louise
Gait Analysis Laboratory, Central Remedial Clinic, Vernon Avenue, Clontarf, Dublin 3, Ireland; School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
School of Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
Gait Posture. 2019 Feb;68:300-304. doi: 10.1016/j.gaitpost.2018.12.011. Epub 2018 Dec 6.
Toe-walking is a normal variant in children up to 3 years of age but beyond this a diagnosis of idiopathic toe-walking (ITW) must be considered. ITW is an umbrella term that covers all cases of toe-walking without any diagnosed underlying medical condition and before assigning these diagnosis potential differential diagnoses such as cerebral palsy, peripheral neuropathy, spinal dysraphism and myopathy must be ruled out. Gait laboratory assessment (GLA) is thought to be useful in the evaluation of ITW, and kinematic, kinetic and electromyography features associated with ITW have been described. However, the longer term robustness of a diagnosis based on GLA has not been investigated. The primary aim of this study was to examine if a diagnosis of ITW based on GLA features persisted.
All patients referred to a national gait laboratory service over a ten year period with queried ITW were sent a postal survey to establish if a diagnosis of ITW which had been offered following GLA persisted over time. The gait and clinical parameters differentiating those reported as typical ITW and not-typical-ITW following GLA were examined in the survey respondents.
Of 102 referrals to the laboratory with queried ITW, a response rate of 40.2% (n = 41) was achieved. Of the respondents, 78% (n = 32) were found to be typical of ITW following GLA and this diagnosis persisted in the entire group at an average of 7 years post GLA. The other nine subjects were reported as not typical of ITW following GLA and 44.4% (n = 4) received a subsequent differential diagnosis. The clinical examination and gait analysis features differentiating these groups were consistent with previous literature.
GLA appears to be a useful objective tool in the assessment of ITW and a diagnosis based on described features persists in the long-term.
对于3岁以下儿童，踮脚走路是一种正常现象，但超过这个年龄则必须考虑特发性踮脚走路（ITW）的诊断。ITW是一个统称，涵盖所有无已确诊潜在疾病的踮脚走路病例，在做出这些诊断之前，必须排除诸如脑瘫、周围神经病变、脊柱裂和肌病等潜在的鉴别诊断。步态实验室评估（GLA）被认为对ITW的评估有用，并且已经描述了与ITW相关的运动学、动力学和肌电图特征。然而，基于GLA的诊断的长期稳定性尚未得到研究。本研究的主要目的是检查基于GLA特征的ITW诊断是否持续存在。
在十年期间转诊至国家步态实验室服务且被怀疑患有ITW的所有患者都收到了一份邮寄调查问卷，以确定在GLA后做出的ITW诊断是否随时间持续存在。在调查对象中检查了区分GLA后报告为典型ITW和非典型ITW的步态和临床参数。
在102例转诊至实验室且被怀疑患有ITW的患者中，回复率为40.2%（n = 41）。在受访者中，78%（n = 32）在GLA后被发现为典型的ITW，并且在GLA后平均7年时，整个组中该诊断仍然存在。其他9名受试者在GLA后被报告为非典型ITW，44.4%（n = 4）接受了后续的鉴别诊断。区分这些组的临床检查和步态分析特征与先前的文献一致。
GLA似乎是评估ITW的一种有用的客观工具，基于所描述特征的诊断在长期内持续存在。
