Is Idiopathic Toe Walking Really Idiopathic?

NewsBot · Nov 7, 2025

Impact of Gait Events Identification through Wearable Inertial
Sensors on Clinical Gait Analysis of Children with Idiopathic
Toe Walking
Citation: Brasiliano, P.; Mascia, G.; Di
Feo, P.; Di Stanislao, E.; Alvini, M.;
Vannozzi, G.; Camomilla, V.
Micromachines 2023, 14, 277.

Abstract: Idiopathic toe walking (ITW) is a gait deviation characterized by forefoot contact with the
ground and excessive ankle plantarflexion over the entire gait cycle observed in otherwise-typical
developing children. The clinical evaluation of ITW is usually performed using optoelectronic
systems analyzing the sagittal component of ankle kinematics and kinetics. However, in standardized
laboratory contexts, these children can adopt a typical walking pattern instead of a toe walk, thus
hindering the laboratory-based clinical evaluation. With these premises, measuring gait in a more
ecological environment may be crucial in this population. As a first step towards adopting wearable
clinical protocols embedding magneto-inertial sensors and pressure insoles, this study analyzed the
performance of three algorithms for gait events identification based on shank and/or foot sensors.
Foot strike and foot off were estimated from gait measurements taken from children with ITW
walking barefoot and while wearing a foot orthosis. Although no single algorithm stands out as
best from all perspectives, preferable algorithms were devised for event identification, temporal
parameters estimate and heel and forefoot rocker identification, depending on the barefoot/shoed
condition. Errors more often led to an erroneous characterization of the heel rocker, especially in
shoed condition. The ITW gait specificity may cause errors in the identification of the foot strike
which, in turn, influences the characterization of the heel rocker and, therefore, of the pathologic
ITW behavior.
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NewsBot · Dec 7, 2025

Persistent Toe Walking as a Prominent Feature in Pediatric PMP22- Related Neuropathies: A Retrospective Cohort Study
Pomarino David et al
Global Medical Genetics

Purpose
Persistent toe walking in children is often considered idiopathic; however, increasing evidence suggests that alterations in the PMP22 gene—implicated in Charcot–Marie–Tooth disease type 1 A (CMT1A) and Hereditary Neuropathy with Liability to Pressure Palsies (HNPP)—may contribute to its pathogenesis. This study investigates the association between PMP22 variants (duplications, deletions, and point mutations) and toe walking in children, aiming to delineate their clinical and genetic characteristics.
Methods
A retrospective analysis was performed on 22 pediatric patients (mean age: 7.7 years) with persistent toe walking and confirmed PMP22 variants identified through a 49-gene next-generation sequencing (NGS) panel. In selected cases, Multiplex Ligation-dependent Probe Amplification (MLPA) was applied to confirm copy number variations. Comprehensive clinical evaluations included musculoskeletal, neurological, and developmental assessments.
Results
All identified variants demonstrated dominant inheritance. Pathogenic variants were present in 54.5% of patients, likely pathogenic in 31.8%, and variants of uncertain significance (VUS) in 13.6%. Among pathogenic cases, most carried PMP22 duplications, one had a deletion, and the remainder harbored the missense variant p.(Thr118Met). The three VUS carriers exhibited comparatively milder phenotypes, such as muscle cramps, lumbar hyperlordosis, mild dorsiflexion restriction, hyporeflexia, pes cavus, and clinodactyly/brachydactyly; only one presented with tremor. Lumbar hyperlordosis (90.9%) and pes cavus (90.9%) were the most consistent findings.
Conclusions
Persistent toe walking may represent an early sign of PMP22-related neuropathies rather than a benign idiopathic gait pattern. The predominance of PMP22 duplications and characteristic neuromuscular features highlight the clinical utility of integrating NGS and MLPA testing for accurate diagnosis, targeted management, and genetic counseling.
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Is Idiopathic Toe Walking Really Idiopathic?

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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Is Idiopathic Toe Walking Really Idiopathic?

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Unraveling the mysteries of idiopathic toe walking (Melbourne)

Neuropsychiatric symptoms and problems among children with idiopathic toe-walking

The Prevalence and Course of Idiopathic Toe-Walking in 5-Year-Old Children

Online survey on idiopathic toe walking and Quality of Life

Online survey on idiopathic toe walking and Quality of Life

Idiopathic toewalking in children

Idiopathic toe walking and sensory processing dysfunction

Share This Page

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