Toe Walking in Autism Specturm Disorders

NewsBot · May 21, 2012

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Idiopathic Toe Walking in Autism Spectrum Disorders and Associated Clinical Features
Thursday, May 17, 2012; International Meeting for Autism Research
L. B. Krantz, T. N. Takahashi, K. Hughes, M. O. Mazurek and K. Sohl

Background:
Previous research and clinical observations have indicated that children with autism spectrum disorders (ASD) often exhibit motor impairments and gait abnormalities. Among these, idiopathic toe-walking (ITW) appears to occur at a particularly high rate. However, few studies have specifically examined the incidence, prevalence, or associated features of ITW in this population. Idiopathic toe-walking is generally defined as toe-walking that persists for longer than 3 months after independent walking begins—with all other physiological and anatomical causes being excluded.

Objectives:
The primary purpose of this study was to examine the prevalence of ITW among children with varying ASD subtypes. Our second objective was to determine whether toe-walking is correlated with differences in specific clinical features and measures of severity among children with ASD.

Methods:
Retrospective data were examined from 829 children and adolescents with ASD seen in an outpatient autism specialty clinic between 1994 and 2010. Participants ranged in age from 3 to 20 (average age of 8.0 years). Regarding diagnosis, 57.5% met diagnostic criteria for Autistic Disorder, 27.6% for PDD NOS, and 14.8% for Asperger's Syndrome. Toe-walking was determined from a parent-report history questionnaire completed at intake. Possible non-idiopathic causes of toe-walking were excluded by excluding children with abnormal MRIs or extreme prematurity. For a subset of the population, additional measures of associated clinical features were examined. Measures included Full Scale IQ (n=257), Social Communication Questionnaire (SCQ) (n=150), Vineland Adaptive Behavior Scale – 2nd Edition Communication Subscale (n=228), Child Behavior Checklist Externalizing (CBCL) Symptoms subscale (n=209), and Short Sensory Profile (SSP) (n=189).

Results:
Results indicated that prevalence of idiopathic toe-walking was high (40.5%). Autistic Disorder had the highest overall prevalence (45.1%), with a lower prevalence among those with Asperger's Syndrome (30.1%). Differences between children with and without a history of ITW were examined using ANCOVA analyses controlling for age. Children with a history of ITW had significantly higher scores on the SCQ (p < .01) and CBCL Externalizing Scale (p < .05) and significantly lower IQ (p < .01) and SSP scores (p < .01). No significant differences were found on the Vineland Communication Scale. Logistic regression analysis was used to examine subscale scores of the SSP, and results indicated that the “under responsiveness/sensation seeking” category was a statistically significant predictor of history of ITW.

Conclusions:
The results of the current study show that a history of idiopathic toe-walking is very prevalent in children with ASD. ITW is associated with greater autism severity, and those with a history of ITW had lower cognitive functioning, greater difficulty with behavioral regulation, and more impaired sensory processing. These findings indicate that ITW may be a biomarker of poorer outcomes for children with ASD. Future studies using prospective, longitudinal designs and standardized measures of motor impairment would be helpful to more fully investigate these issues.
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Bug · May 22, 2012

You know, this is one of the things that really gripes me, it isn't ITW or idiopathic toe walking, it's toe walking associated with ASD or autism.

I guess the devil is in the detail, in that, it still isn't known though with children who have autism what causes the toe walking. It's a good prompt though for health clinicians who in my exprience seem to think that most toe walking is ITW. It isn't.

Kevin Kirby · May 22, 2012

Bug said: ↑

You know, this is one of the things that really gripes me, it isn't ITW or idiopathic toe walking, it's toe walking associated with ASD or autism.

I guess the devil is in the detail, in that, it still isn't known though with children who have autism what causes the toe walking. It's a good prompt though for health clinicians who in my exprience seem to think that most toe walking is ITW. It isn't.
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Cylie:

Sounds like a great paper for you to write...on "idiopathic" toe walking, Cylie. If you wanted, it would be a great article for Podiatry Today Magazine or, even better, a literature review article with case report for JAPMA.

Just trying to help you to help the rest of us.:drinks

Here's my private e-mail if you have any interest. kevinakirby@comcast.net

Admin2 · Sep 6, 2013

Related threads:
Other threads tagged with autism
Other threads tagged with toe walking
Gait analysis to identify autism
Motor control intervention for toe walking
Asperger's affecting gait?
Neuropsychiatric symptoms and problems among children with idiopathic toe-walking
Can an autistic boy chronic tip toe walking walk normal?

NewsBot · Sep 6, 2013

Brief Report: An Evaluation of TAGteach Components to Decrease Toe-Walking in a 4-Year-Old Child with Autism
Angela Persicke, Marianne Jackson, Amanda N. Adams
Journal of Autism and Developmental Disorders; September 2013

The current study evaluated the effectiveness of using a modified TAGteach™ procedure and correction to decrease toe-walking in a 4-year-old boy with autism. Two conditions were analyzed: correction alone and correction with an audible conditioned reinforcing stimulus. Correction alone produced minimal and inconsistent decreases in toe-walking but correction with an audible conditioned stimulus proved most effective in reducing this behavior. This has implications for decreasing toe-walking in other children with autism and may be easily used by teachers and parents.
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NewsBot · Dec 30, 2015

Toe walking in autism: further observations.
Accardo PJ, Barrow W
J Child Neurol. 2015 Apr;30(5):606-9

Toe walking has been associated with language disorders and autism. To better understand the association between persistent toe walking and sensory and motor variables in children with autism, the degree of toe walking was compared with an estimate of the severity of sensory integration dysfunction symptoms and the presence of residual components of the tonic labyrinthine in supine reflex pattern in 61 children younger than 37 months of age with newly diagnosed autism. There was no association between the presence of toe walking and sensory symptoms (P = .5298) or language age (P = .6142), but there was an association between toe walking and the presence of components of the tonic labyrinthine reflex (P = .04222). These preliminary results support the contribution of subtle motor deficits to the evolution of some behaviors associated with autism.
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NewsBot · Apr 7, 2017

Assessment of presentation patterns, clinical severity, and sensorial mechanism of tip-toe behavior in severe ASD subjects with intellectual disability: A cohort observational study.
Valagussa G et al
Autism Res. 2017 Apr 6. doi: 10.1002/aur.1796

We assessed presentation patterns and characteristics of tip-toe behavior (TTB), more commonly known as toe walking, in a cohort of severe autism spectrum disorder (ASD) subjects with intellectual disability in two studies. The first study included 69 consecutive ASD subjects (57 males, mean age = 14 years-3.7 SD) under observation at our institute. A therapist assessed the presence of TTB during standing, walking, and running through direct observation and an interview with the subjects main caregiver. The prevalence of TTB was 32%. We found three clinical presentation patterns of TTB: (1) present when standing, walking and running (45.5%), (2) present when walking and running (18.4%), or (3) present only when running (36.4%). TTB subjects were more frequently nonverbal than those without TTB (72.7% vs. 44.6%-P = 0.03). On the other hand, no significant difference in ASD severity according to the ADOS scale was found between TTB and non-TTB subjects. In the second study, carried out in a subgroup of 14 ASD subjects (7 TTB and 7 non-TTB), we evidenced that a soft floor surface (foam mats) made a substantial difference in reducing the TTB phenomenon. TTB is frequently present in ASD individuals and may occur in three mutually exclusive modalities, which ultimately defines what is commonly known as toe walking. The presence of TTB seems correlated to the severity of language delay. Foot contact on soft surfaces reduces TTB both during static and/or dynamic tasks. Further evaluation is needed to clarify the potential pathophysiological implications of this phenomenon
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NewsBot · Jun 29, 2017

Kinematic Gait Changes Following Serial Casting and Bracing to Treat Toe Walking in a Child With Autism.
Barkocy M, Dexter J, Petranovich C.
Pediatr Phys Ther. 2017 Jul;29(3):270-274. doi: 10.1097/PEP.0000000000000404.

PURPOSE:
To evaluate the effectiveness of serial casting in a child with autism spectrum disorder (ASD) exhibiting a toe-walking gait pattern with equinus contractures.
SUMMARY OF KEY POINTS:
Although many children with ASD toe walk, little research on physical therapy interventions exists for this population. Serial casting has been validated for use in idiopathic toe walking to increase passive dorsiflexion and improve gait, but not for toe walking in children with ASD. Serial casting followed by ankle-foot orthosis use was implemented to treat a child with ASD who had an obligatory equinus gait pattern. Gait analysis supported improvements in kinematic, spatial, and temporal parameters of gait, and the child maintained a consistent heel-toe gait at 2-year follow-up. STATEMENT OF CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE:: Serial casting followed by ankle-foot orthosis use is a viable treatment option for toe walking in children with ASD.
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NewsBot · Jan 7, 2018

Kinematic Gait Changes Following Serial Casting and Bracing to Treat Toe Walking in a Child With Autism.
Barkocy M, Dexter J, Petranovich C.
Pediatr Phys Ther. 2017 Jul;29(3):270-274. doi: 10.1097/PEP.0000000000000404.

PURPOSE:
To evaluate the effectiveness of serial casting in a child with autism spectrum disorder (ASD) exhibiting a toe-walking gait pattern with equinus contractures.

SUMMARY OF KEY POINTS:
Although many children with ASD toe walk, little research on physical therapy interventions exists for this population. Serial casting has been validated for use in idiopathic toe walking to increase passive dorsiflexion and improve gait, but not for toe walking in children with ASD. Serial casting followed by ankle-foot orthosis use was implemented to treat a child with ASD who had an obligatory equinus gait pattern. Gait analysis supported improvements in kinematic, spatial, and temporal parameters of gait, and the child maintained a consistent heel-toe gait at 2-year follow-up. STATEMENT OF CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE:: Serial casting followed by ankle-foot orthosis use is a viable treatment option for toe walking in children with ASD.
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NewsBot · Apr 10, 2018

The use of a multiple schedule to decrease toe walking in a child with autism
Ansley C. Hodges David A. Wilder Hallie Ertel
Behavioural Interventions : 30 March 2018

We evaluated a procedure in which a wristband worn by a young boy with autism signaled the availability of praise for appropriate walking and the delivery of reprimands for toe walking. In the absence of the wristband, no programmed consequences were delivered for appropriate walking or toe walking. Once toe walking decreased to criterion levels with the wristband on, we increased the number of steps during which the participant wore the wristband. Results suggest that the procedure was effective to decrease toe walking in both clinic and community settings. To assess generalization, we had the participant's mother implement the procedure; it remained effective when implemented by her.
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NewsBot · Apr 27, 2018

Lower-extremity rotational profile and toe-walking in preschool children with autism spectrum disorder.
Arik A et al
J Pediatr Orthop B. 2018 Apr 24. doi: 10.1097/BPB.0000000000000519

The aim of this study was to establish the torsional and toe-walking profiles of children with autism spectrum disorder (ASD), and to analyze the correlations between torsion, toe-walking, autism severity score, and age. In total, 79 consecutive children with autism were examined to determine their hip rotations, thigh-foot angle, degree of toe-walking, and autism severity. Femoral and tibial torsion values, of the preschool patients, were compared statistically with age-matched controls. The hip rotation profile of the patients was similar to the normal group. Nearly a half of the patients with ASD present excessive external tibial torsion. The difference in the tibial torsion between patients and normal children was statistically significant. A weak correlation was found only between tibial torsion and the autism severity score, but no correlation was found between the other parameters. External tibial torsion is the cardinal and persistent orthopedic manifestation among patients with ASD. Toe-walking is the second most common such manifestation and is an independent orthopedic feature in these patients. External tibial torsion may potentially contribute toward the described gait abnormalities in patients with ASD.
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Tess Bowen · Jun 20, 2018

NewsBot said: ↑

Idiopathic Toe Walking in Autism Spectrum Disorders and Associated Clinical Features
Thursday, May 17, 2012; International Meeting for Autism Research
L. B. Krantz, T. N. Takahashi, K. Hughes, M. O. Mazurek and K. Sohl
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Tess Bowen · Jun 20, 2018

Is there a link between ITW and early signs of schizophrenia ?

NewsBot · Sep 17, 2018

Toe Walking Assessment in Autism Spectrum Disorder Subjects: A Systematic Review
Giulio Valagussa Luca Trentin Alessio Signori Enzo Grossi
Autism Research: 10 September 2018

There is increasing evidence that autism spectrum disorder (ASD) subjects have also motor impairments. Toe walking (TW) is a phenomenon that can be found in ASD subjects during gait, even if this condition was found not to be necessarily related only to walking, since these children often also stand and run on their tiptoes. Since persistent TW in ASD subjects may contribute to secondary shortening of the Achilles's tendon, it becomes important to have an assessment tool and/or outcome measure for both the clinical and rehabilitative settings. The aim of this systematic review is to critically evaluate and describe the methods employed to assess toe walking in ASD subjects. The systematic review protocol was previously registered on PROSPERO. We conducted an extensive literature search in PubMed, CINAHL, PsycINFO, The Cochrane Library, and Scopus databases. There were no restrictions on the types of study design eligible for inclusion. Ten studies were included in the systematic review. Risk of bias of the included studies was conducted using the following instruments depending on the study types: STROBE Statement, Cochrane risk of bias tool, and CARE checklist. Almost all the included studies (8/10) proposed a tip‐toe behavior (TTB) assessment only during walking. Nine out of ten of the included studies assessed TTB using a qualitative methodology. The results evidenced the heterogeneity of qualitative methods and a lack of a structured quantitative test to assess toe walking in ASD subjects.
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NewsBot · Sep 21, 2018

Lower extremity joint stiffness during walking distinguishes children with and without autism
Jeffrey D.EgglestonaJohn R.HarrybJanet S.Dufekc
Human Movement Science; Volume 62, December 2018, Pages 25-33

Highlights
•Children with ASD exhibit differences in lower extremity joint stiffness.
•Stiffness differences contribute to inefficient push-off during gait.
•Differences may be due to sensory processing dysfunction in children with ASD.
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How children with Autism Spectrum Disorder (ASD) and peers with typical development (TD) modulate lower extremity stiffness during walking could identify a mechanism for gait differences between groups. We quantified differences in lower extremity joint stiffness and linear impulses, along the vertical and anterior/posterior axes during over-ground walking in children with ASD compared to age- and gender-matched children with TD. Nine age- and gender-matched pairs of children, aged 5–12 years, completed the current study. Joint stiffness and linear impulses were computed in four sub-phases of stance: loading response, mid-stance, terminal stance, and pre-swing. The Model Statistic technique (α = 0.05) was used to test for statistical significance between the matched-pairs for each variable and sub-phase. Furthermore, dependent t-tests (α = 0.05) were utilized, at the group level, to determine whether significant differences existed between sub-phases. Results indicate that children with ASD may exhibit greater stiffness in pre-swing, and thus, produce inefficient propulsive forces during walking. We attribute these differences to sensory processing dysfunction previously observed in children with ASD.
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NewsBot · Jul 6, 2019

Autism and toewalking: are they related? Trends and treatment patterns between 2005 and 2016.
Leyden J, Fung L, Frick S.
J Child Orthop 2019;13. DOI: 10.1302/

Purpose This study quantified toe-walking trends and treatment decisions in patients with autism spectrum disorder
(ASD) in the United States between 2005 and 2016 using a
large national private-payer database.
Methods A retrospective database review was performed on
paediatric patients with ASD, and for International Classification of Diseases-9/10 diagnosis codes for toe-walking. Patients
were filtered based on treatment type by Current Procedural
Terminology (CPT) code. Continued toe-walking rates were
assessed for each patient population and treatment group.
A Pearson’s chi-squared test was used to evaluate differences
in group characteristics.
Results Of 2 221 009 paediatric patients in the database,
5739 patients had a diagnosis of ASD, and 8.4% of patients
with ASD also had a diagnosis of toe-walking (n = 484). For
typically developing children in the database, 0.47% of patients had a diagnosis of persistent toe-walking. In all, 59.3%
of ASD patients underwent physical therapy, 7.4% serial
casting and 3.3% surgical correction, compared with 38.1%,
3.6% and 1.2% of normally developing children, respectively (chi-square 6.4031; p < 0.040699). Without intervention,
63.6% of patients with ASD continued to toe-walk within ten
years of their diagnosis, with 19.3% of patients without ASD
(chi-square 82.9762; p < 0.0001).
Conclusion This study supports the association between a
greater prevalence of toe-walking in children with ASD. We
showed that patients with ASD and toe-walking receive surgical correction at nearly triple the rate of children without ASD
who toe-walk. The continued rate of toe-walking is comparable between treatment groups as well as between ASD and
typically developing children. Typically developing children
have higher rates of toe-walking resolution without intervention than children with ASD.
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NewsBot · Jul 17, 2019

The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism
David A. Wilder Hallie Ertel Ansley C. Hodges Rachel Thomas Nga Luong
10 July 2019

We replicated and extended previous research on the use of auditory feedback to decrease toe walking exhibited by 3 children with autism. After pretreatment screening analyses suggested that toe walking occurred independent of social consequences, we attached squeakers to the heels of each participants' shoes. The squeakers provided auditory feedback when participants walked appropriately (i.e., with a heel‐to‐toe gait). For all participants, the auditory feedback itself produced increases in appropriate walking. For 1 participant, this feedback was sufficient to reduce toe walking to clinically acceptable levels; however, for 2 other participants, delivery of edible items paired with the auditory feedback was necessary. Intervention effects maintained when the schedule for edible delivery was thinned for all participants. In addition, for 2 participants, effects maintained when the intervention was implemented in a different setting and with a different person with no edibles or a thin schedule of edibles.
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NewsBot · Oct 9, 2019

Toe Walking Assessment in Autism Spectrum Disorder Subjects: A Systematic Review
Giulio Valagussa Luca Trentin Alessio Signori Enzo Grossi
Autism Res 2018, 11: 1404–1415.

There is increasing evidence that autism spectrum disorder (ASD) subjects have also motor impairments. Toe walking (TW) is a phenomenon that can be found in ASD subjects during gait, even if this condition was found not to be necessarily related only to walking, since these children often also stand and run on their tiptoes. Since persistent TW in ASD subjects may contribute to secondary shortening of the Achilles's tendon, it becomes important to have an assessment tool and/or outcome measure for both the clinical and rehabilitative settings. The aim of this systematic review is to critically evaluate and describe the methods employed to assess toe walking in ASD subjects. The systematic review protocol was previously registered on PROSPERO. We conducted an extensive literature search in PubMed, CINAHL, PsycINFO, The Cochrane Library, and Scopus databases. There were no restrictions on the types of study design eligible for inclusion. Ten studies were included in the systematic review. Risk of bias of the included studies was conducted using the following instruments depending on the study types: STROBE Statement, Cochrane risk of bias tool, and CARE checklist. Almost all the included studies (8/10) proposed a tip‐toe behavior (TTB) assessment only during walking. Nine out of ten of the included studies assessed TTB using a qualitative methodology. The results evidenced the heterogeneity of qualitative methods and a lack of a structured quantitative test to assess toe walking in ASD subjects.
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NewsBot · Dec 26, 2019

Wearable devices to help children with autism overcome
toe walking
Andrea Mennitto et al
Source

One of the first symptoms of Autism Spectrum Disorder is "Toe-Walking", a walking mode in which the person uses only the tip of the foot, without
bringing the heel to the ground. Common in toddlers, children with ASD continue
to use this pattern growing up. Toe Walking can lead to the development of secondary motor deformity, the shortening of a heel cord, whose treatment may require surgery (eg. tendon lengthening).
Aim of this study is to analyze behavioral interventions, which are non-invasive
and easily integrated with rehabilitation activities already in place in the centers
and homes of many young people with ASD. The research team will then present
a proposal for a technological evolution on this issue, in order to develop a system
for early diagnosis and treatment.
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NewsBot · Jun 3, 2020

Case Report: Lymphatic Drainage Resolves Toe Walking Gait in a Boy with Autism Spectrum Disorder
Susan Vaughan Kratz
Int J Foot Ankle 2020, 4:039

Objective: Describe how lymphatic drainage (LD) resolved

obligatory toe walking gait and stance in a boy with Autism
Spectrum Disorder (ASD). The treatment plan was generalized from an identical treatment given to a collegiate athlete
with chronic spasms of gastronemii.
Design: Review of medical record; photography evidence.
Intervention: A single treatment of LD. No literature suggests a fluid anatomy model for manual therapies as treatment options for toe walking. This case highlights an effective
method discovered to quickly reverse functional deformities
despite several years of traditional pediatric interventions for
toe walking in ASD.
Results: Full weight bearing contact of bilateral plantar surfaces was gained in stance immediately. Active-assisted
range of motion and progressive resistance training began
to progress only after this breakthrough. Gains have since
been made in gait and stance normalization, and foot kinetics. More invasive interventions (serial casting; reconstructive surgery) have been avoided. Gains sustained as
evidenced in one year follow up.
Conclusion: Emerging paradigm of lymphatic and interstitial anatomy provides novel treatment to change the functional status of muscle tissue and tone. Changes in passive
and active ankle range of motion were a direct result of mobilizing and evacuating fluids of the gastrocnemii via lymphatic pathways. Spontaneous muscle softening and Achilles tendon lengthening happened instantly. An extremely
light touch and pressure input from the therapist is required
to perform lymphatic drainage. Lymphatic drainage massage holds promise for further use and study with issues
such as toe walking gait and other orthopedic populations.
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NewsBot · Jul 3, 2020

The Effects of Clicker Training to Increase Heel-To-Toe Walking in Three Children with Autism Spectrum Disorder
Grinbergs, Joshua.
Temple University, ProQuest Dissertations Publishing, 2020. 27834961.

This current study was an extension of Persicke et al. (2014) and was conducted to
evaluate the effectiveness of clicker training on increasing the amount of heel-to-toe strides for
three children with Autism Spectrum (ASD). Persicke et al. assessed the effectiveness of
TAGteach™ procedures in combination with a correction procedure. This current study used
only the clicker training phase. The results of the current study suggest that clicker training can
serve as an effective intervention to increase heel-to-toe strides, thereby decreasing toe walking.
Baseline levels of all participant’s heel-to-toe strides were below 30% of steps. All three
participants increased their heel-to-toe steps above 80% following the implementation of clicker
training, and results maintained throughout all fading trials. Social validity measures indicated
that clicker training was easy to use and understand. Future research should investigate
delivering an auditory stimulus through a device other than a clicker to increase the treatment
fidelity and social validity due to a clicker being associated with animal training. This research
demonstrated that clicker training can be a viable intervention for children with Autism
Spectrum Disorder who exhibit toe walking
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NewsBot · Aug 29, 2020

Relationship between tip-toe behavior and soleus - Gastrocnemius muscle lengths in individuals with autism spectrum disorders
GiulioValagussa et al
Journal of Orthopaedics; 20 August 2020

Background
About 20% of individuals with autism spectrum disorders (ASD) showed tip-toe behavior (TTB). This behavior may be related to a decreased ankle joint range of motion (ROM) in dorsiflexion. Physiologically, gastrocnemius (GM) and soleus (SM) muscle influence ankle ROM independently. However, no studies investigated the relationship between the amount of time individuals with ASD spend in TTB and GM and SM muscle lengths.

Objective
To evaluate the relationship between three mutually exclusive clinical patterns of TTB i.e., during standing, walking and running (TTB Class 1), or during walking and running (TTB Class 2), or only when running (TTB Class 3), and GM and SM muscle lengths.

Methods
Sixty-nine individuals with ASD (average age: 14.1 ± 3.6 years, 56 males) were enrolled. In a clinical setting, SM and GM muscle lengths of both legs were assessed through a manual goniometer. Measurements were performed by two trained assessors blinded to TTB classifications.

Results
Individuals with ASD classified as TTB Class 1 demonstrated a shortening of both GM and SM compared with NON-TTB and TTB Class 3 individuals.

Conclusions
Our results support the relationship between TTB severity and GM and SM shortening assessed by a decreased ankle joint ROM in dorsiflexion. Further studies are needed to determine the factors associated with TTB and decreased ankle ROM.
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NewsBot · Mar 16, 2021

The Effectiveness of Serial Casting and Ankle Foot Orthoses in Treating Toe Walking in Children With Autism Spectrum Disorder
Marybeth Barkocy et al
Pediatr Phys Ther. 2021 Mar 9

Purpose: This proof of concept study examined the effectiveness of serial casting (SC) and ankle foot orthoses (AFOs) in children with autism spectrum disorder (Ch-ASD) who toe walk (TW). Data collected determined effects of SC, followed by AFO intervention on ankle dorsiflexion (A-DF) passive range of motion and kinematics, and parent-reported functional outcomes for children with autism spectrum disorder who TW and have limited A-DF passive range of motion.

Summary of key points: The 5 participants increased passive range of motion with SC, except for 1 participant's left ankle. Two of 4 participants had near typical A-DF kinematic patterns following SC. The 5 participants improved A-DF during walking following 6 months of AFO use.

Conclusions: Serial casting increased A-DF ROM and kinematics during walking. Consistent AFO use for walking training improved function and reduced toe walking. Serial casting followed by AFOs is a potential intervention for children with autism spectrum disorder who TW.
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NewsBot · Jun 10, 2021

Interventions for Toe Walking in Individuals with Autism Spectrum Disorders: A Systematic Review

NewsBot · Dec 30, 2021

Therapy Suit Without and With Exercises Corrective of Effect the of Comparison
Walking Toe With Children Autism in Balance and Kinematic Gait on
Iran, Kish et al
Source

Background
autistic in balance and gait affect positively can exercises Corrective. patterns movement changes and
support and pressure balance that bands elastic and hooks with jointed is therapy suit The. children
therapy suit without and with exercise corrective of effect the compares study This. joints and muscles
.walking toe with children autistic in balance and kinematic gait on
5.19±4.106= height, years 7.1±7.5= age: SD±Mean (walking toe with boys autistic 30 of group A Methods
randomly then and study this in purposefully and voluntarily chosen were) kg 8.5±8.20= weight and, cm
corrective of weeks 8 received groups Both. therapy suit without and with of groups two into assigned
and Paired. posttest and pre the in evaluated were) Tinetti (balance and) analysis movement mensionaldi Tree (kinematic gait cases The. hours 2 for session each, week per sessions 5 including, exercises
.16. v SPSS using analyses statistical for used were test-t independent
length stride in effective more significantly was therapy suit with group exercises corrective the in mentTreat. groups two the between kinematic gait the in difference significant a revealed result The Results
in dorsiflexion ankle), 001.0=P (speed walking), 021.0=P (width step), 001.0=P (length step), 001.0=P(
.group therapy suit without exercises corrective that than phase) 001.0=P (swing and), 001.0=P (stance
cadence), 444.0=P (time stride in observed was difference significant no, groups two these between But
no showed also study the of results The). 135.0=P (flexion hip and), 614.0=P (foot deviation), 361.0=P(
.groups between) 927.0=P (balance in difference significant
.therapy suit without ones than effective more are therapy suit with exercises Corrective Conclusion
.walking toe with boys autistic for suggested are therapy suit with sessions exercises corrective, Therefore
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NewsBot · Jan 3, 2022

Evaluation of shoe inserts to reduce toe walking in young children with autism
David A. Wilder,Grant Ingram,Ansley C. Hodges
29 December 2021

Toe walking is relatively common among children with autism spectrum disorder and, if untreated, can contribute to a number of medical problems. Previous research has suggested that toe walking may vary by walking surface. Some (e.g., rough) surfaces may inhibit toe walking, whereas other surfaces may encourage it. In the current study, we first conducted a functional analysis screening to verify that toe walking exhibited by two young children with autism was maintained by automatic reinforcement. Next, we assessed toe walking on a variety of surfaces, including tile, artificial grass, and grip tape. Finally, we placed inserts of the surface associated with the lowest level of toe walking into each participant's shoes. The inserts were effective to nearly eliminate toe walking by one participant and reduce toe walking to low levels for the second participant. To decrease the second participant's toe walking further, we added a hand-on-shoulder procedure, which was also effective. We discuss the results in terms of the putative mechanisms responsible for the reduction.
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NewsBot · Jun 21, 2022

Little Evidence for Conservative Toe Walking Interventions in Autism Spectrum Disorders: a Systematic Review
Giulio Valagussa, Daniele Piscitelli, Silvia Baruffini, Valentina Panzeri, Cecilia Perin, Miryam Mazzucchelli, Cesare Maria Cornaggia, Leonardo Pellicciari & Enzo Grossi
Review Journal of Autism and Developmental Disorders (2022)

This systematic review summarizes the evidence about toe walking (TW) interventions in persons with autism. Following the PRISMA guidelines, a systematic search of MEDLINE, CINAHL, PsycINFO, The Cochrane Library, Google Scholar, and Opengrey was performed. Nine articles (all case reports or case series) were included. Methodological quality was assessed using the Mayo Evidence-Based Practice Centre tool. The included studies considered 17 subjects (16 males; age range: 4–15 years). All studies reported a reduction of TW frequency, but the follow-up was lacking in seven studies. There is a lack of high-quality studies with a sufficiently large and well-characterized sample to assess the effectiveness of TW interventions in autistic persons. These findings strongly support the need for further research in this area.
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NewsBot · Jul 11, 2022

Chiropractic management of toe-walking in an eight-year-old male diagnosed with autism spectrum disorder utilizing a functional approach: A case study
Trevor Shaw et al
March 29, 2021

Objective
The objective of this paper is to discuss the treatment of idiopathic toe-walking utilizing cognitive-motor dual-tasking and primitive reflex integration exercises.
Methods
An eight-year-old child with the previous diagnosis of autism spectrum disorder and idiopathic toe-walking presents for chiropractic care. The patient had previously received eight months of physical therapy in which his results plateaued after three months of care.
Results
On the initial visit, the child was evaluated for primitive reflexes. The patient retained the asymmetrical tonic neck reflex and palmer grasp. He was prescribed exercises to integrate these reflexes. In the second visit and onwards, the patient was tasked with walking while performing a cognitive or motor task. The patient’s performance of primitive reflex attenuation exercises significantly improved in form and timing, and the patient achieved proper gait mechanics with most interventions used.
Conclusion
Due to the limited number of visits, the patient was prescribed a cognitive task to help facilitate the retention of proper gait mechanics; however, these findings suggest that chiropractic management may prove useful in children who toe walk and that further investigation into treatment utilizing primitive reflex integration exercises for children with psychomotor delays is warranted. We suggest that the integration of primitive reflex testing for the chiropractor can yield many answers and serve as a valuable rehabilitation approach.
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NewsBot · Sep 6, 2022

Sensory Profile of Children and Adolescents with Autism Spectrum Disorder and Tip-Toe Behavior: Results of an Observational Pilot Study
Giulio Valagussa et al
Children 2022, 9(9), 1336; https://doi.org/10.3390/children9091336

Atypical sensory processing is frequently reported in persons with autism spectrum disorders (ASD), and it is one of the described diagnostic criteria for ASD. There is also mounting literature supporting the presence of motor impairments in individuals with ASD. Among these motor signs, tip-toe behavior (TTB) is a possible clinical finding, but its etiology is not clearly understood. It is suggested that TTB in ASD could be a sign of a sensory modulation impairment, but evidence is lacking and controversial. The main aim of this pilot study is to explore sensory features in a sample (4 females; 28 males) of children and adolescents with ASD (age range: 7–18). All participants also presented Intellectual Disability. Participants were divided in two groups, matched for age and gender, on the basis of the presence or absence of TTB (16 ASD TTB group vs. 16 ASD NO-TTB group) and then evaluated by using the Short Sensory Profile. We found that both ASD groups tend to significantly present sensory-related behavioral symptoms, but ASD TTB individuals more frequently showed the specific pattern of “under responsive/seeks sensation” than ASD NO-TTB individuals. These preliminary findings support that sensory-motor features might be taken into consideration when rehabilitation for TTB in children and adolescents with ASD is necessary
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NewsBot · Oct 26, 2022

SOLEUS AND GASTROCNEMIUS MUSCLE LENGHTS ARE DECREASED IN INDIVIDUALS WITH AUTISM SPECTRUM DISORDERS WITH MODERATE/HIGH TIPTOE BEHAVIOR SEVERITY ACROSS DIFFERENT AGES

NewsBot · Dec 18, 2023

Quantitative assessment of tip-toe behavior in individuals with autism spectrum disorder and intellectual disability: A cross-sectional study
Giulio Valagussa, Giulia Purpura, Valeria Balatti, Luca Trentin, Alessio Signori, Enzo Grossi
18 December 2023

The term “toe walking” describes walking on the toes with a lack of heel strike upon initiation of the stance phase of gait. In individuals with autism spectrum disorder (ASD), this phenomenon, or “tip-toe behavior” (TTB), can be present in a substantial proportion of subjects even during standing. In this study, we investigated TTB in 50 persons with ASD (age range 4–26 years). We evaluated TTB through an observational/report-based assessment protocol. Subsequently, we employed a new structured video-based coding protocol based on standardized video recordings, focusing on static and dynamic conditions. Finally, the findings of the two protocols were compared. Twenty-four subjects with TTB were identified and classified according to three functional groups: TTB1, present only during running (6 subjects); TTB2, present during walking and running (11 subjects); and TTB3, present during standing, walking, and running (7 subjects). Moreover, we found that TTB3 subjects exhibited a significantly higher quantity of TTB compared with subjects in the TTB1 and TTB2 groups during both standing and walking tests. Additionally, a high quantity of TTB in the static test was found to be related to a high quantity of TTB in the dynamic test. Variables such as age, autism severity, intellectual disability, and gender were not significantly associated with the mean percent of TTB both in static and dynamic tests in multivariate analysis. This structured video-based coding approach appears feasible and useful for assessing TTB in individuals with ASD and it has the potential to provide insights into TTB trajectories and aid in designing possible interventions.
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