Joanne Michalitsis1, Anna T Murphy2, Barry Rawicki3, Terry P Haines4, Cylie Williams5. 1. Monash Children's Hospital, Victorian Paediatric Rehabilitation Service, Clayton Rd, Clayton, VIC, 3168, Australia. Electronic address: joanne.michalitsis@monashhealth.org. 2. Monash Health, Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia. 3. Monash Children's Hospital, Victorian Paediatric Rehabilitation Service, Clayton Rd, Clayton, VIC, 3168, Australia. 4. Monash University, School of Primary and Allied Health Care, Frankston, VIC, 3199, Australia. 5. Monash University, School of Primary and Allied Health Care, Frankston, VIC, 3199, Australia; Peninsula Health, Allied Health, 4 Hastings Rd, Frankston, VIC, 3199, Australia.
Abstract
BACKGROUND: There remains a substantial lack of evidence to support the use of foot orthoses as a conservative treatment option for idiopathic toe walking (ITW). Encouraging heel contact during gait is one of the primary goals of most interventions in paediatric ITW. RESEARCH QUESTION: Does the combined treatment of high-top boots and orthoses increase the number of heel contacts during gait and change spatio-temporal gait parameters? METHODS: This within subject designed randomised controlled trial recruited fifteen children diagnosed with ITW (n = 10 males). They were fitted with bilateral custom made rigid contoured carbon fibre foot orthoses placed inside high-top boots. To analyze the effect of this treatment, heel contacts and spatio-temporal parameters measured by an 8.3 m Gaitrite® mat were compared to barefoot walking and shod walking. RESULTS: An immediate increase in heel contact (p = 0.021) was observed in the combined treatment only. Gait changes included a large increase in stride time in the combined treatment condition compared to barefoot walking (p = 0.006). This was associated with a decrease in the percentage of swing phase in the gait cycle (p < 0.010), an increase in stance phase (p < 0.010) and an increase in double support time (p < 0.001). SIGNIFICANCE: These results suggest the hardness and thickness of the shoe and stiffness of the orthosis midsole may lead to improved local dynamic stability and foot position awareness with increased sensory feedback provided through the entire length of the foot. Further research is indicated to validate this treatment option on long term outcomes in this population group.
RCT Entities:
BACKGROUND: There remains a substantial lack of evidence to support the use of foot orthoses as a conservative treatment option for idiopathic toe walking (ITW). Encouraging heel contact during gait is one of the primary goals of most interventions in paediatric ITW. RESEARCH QUESTION: Does the combined treatment of high-top boots and orthoses increase the number of heel contacts during gait and change spatio-temporal gait parameters? METHODS: This within subject designed randomised controlled trial recruited fifteen children diagnosed with ITW (n = 10 males). They were fitted with bilateral custom made rigid contoured carbon fibre foot orthoses placed inside high-top boots. To analyze the effect of this treatment, heel contacts and spatio-temporal parameters measured by an 8.3 m Gaitrite® mat were compared to barefoot walking and shod walking. RESULTS: An immediate increase in heel contact (p = 0.021) was observed in the combined treatment only. Gait changes included a large increase in stride time in the combined treatment condition compared to barefoot walking (p = 0.006). This was associated with a decrease in the percentage of swing phase in the gait cycle (p < 0.010), an increase in stance phase (p < 0.010) and an increase in double support time (p < 0.001). SIGNIFICANCE: These results suggest the hardness and thickness of the shoe and stiffness of the orthosis midsole may lead to improved local dynamic stability and foot position awareness with increased sensory feedback provided through the entire length of the foot. Further research is indicated to validate this treatment option on long term outcomes in this population group.
Authors: Antoni J Caserta; Verity Pacey; Michael Fahey; Kelly Gray; Raoul Hh Engelbert; Cylie M Williams Journal: Cochrane Database Syst Rev Date: 2019-10-06