Do external stimuli impact the gait of children with idiopathic toe walking? A study protocol for a within-subject randomised control trial

INTRODUCTION: Frequently, toe walking gait is the result of disease processes, trauma or neurogenic influences. Idiopathic toe walking (ITW) is, by definition, the diagnosis of a toe walking gait adopted in the absence of one of these medical conditions. Long-term ITW has been associated with reduced ankle range of motion. Reported treatments have included serial casting, Botulinum toxin type A or surgery to improve the ankle range of motion. Investigating the impact of simple and non-invasive treatment options for ITW is important for future research and clinical outcomes. This study investigates the immediate impact of footwear, footwear with orthotics and whole body vibration on ITW to determine if any one intervention improves heel contact and spatial-temporal gait measures. This determination is important for future clinical trials into treatment effectiveness. METHODS AND ANALYSIS: Design: this protocol describes a within-subject randomised controlled trial that measures changes in gait following changes in external stimuli. Participants: 15 children diagnosed with an ITW gait will be recruited from the Victorian Paediatric Rehabilitation Service at Monash Children's Hospital Toe Walking Clinic provided they have ITW and meet the inclusion criteria. Procedure: participants will have their gait recorded walking barefoot, in usual footwear, a custom-made, full-length carbon fibre orthotic in usual footwear and following whole body vibration. Outcome measures will include the presence of bilateral heel contact preintervention and postintervention, stride length (cm), stride width (cm), left and right stride time (s), left and right stance and swing percentage of the gait cycle, gait velocity (m/s), left and right foot toe in/toe out angle (°) and weight-bearing lunge pre and post each condition. ETHICS AND DISSEMINATION: The results of this study will be published at the conclusion and have been approved by Southern Health HREC:12102B. CLINICAL TRIAL REGISTRY NUMBER: ACTRN12612000975897.