Rigid Footplate Shows Advantages Over AFO for Idiopathic Toe Walking

ATLANTA — Researchers are still unsure what causes idiopathic toe walking in children, although data has shown that 30% of children who are idiopathic toe walkers have a family history. The behavior is usually learned when a child first learns to walk, according to Kinsey Herrin, MSPO, CO, Georgia State University, who presented data from a study comparing rigid footplates with articulated AFOs to control the behavior.

“We want to break the toe walking. We don’t want to put them in a device and keep them in a device. We want them in it and out of it,” Herrin said.

The paper was a Thranhardt Lecture finalist presented at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium, here.

Children in the study, who were 2 years to 8 years old, were randomly assigned to either an articulated AFO that blocked planatarflexion at the ankle joint and resisted toe extension at the MTP joint, or a full-length carbon fiber footplate that resisted toe extension at the MTP joint. They were instructed to wear the prescribed orthosis at all times except during sleeping and sports activities.

The researchers had current data on 12 of the 18 children enrolled. After 6 weeks and two follow-up studies, the researchers found that children wore the footplate an average of 12.17 hours per day, and children wore the AFO 10.33 hours per day.

“That’s already got us thinking about the effectiveness of these devices beyond the lab, what it’s like in the real world,” said co-presenter Mark D. Geil, PhD, associate professor of biomechanics at Georgia State University.

The AFOs completely controlled toe walking in the period immediately following the removal of the orthoses, which Geil said was not surprising given the structure of the AFO. The foot orthoses allowed some toe walking immediately post-orthoses.

“Some of the kids really fight that; they use their ankle to overcome what their MTP joint can no longer do,” Geil said.

Over time, however, the acute carryover effect showed a slight advantage for the foot orthosis for reducing toe walking. Geil noted that baseline data in the study was too variable to draw firm conclusions about the results.

Geil M, Herrin K. Is a rigid footplate as effective as an articulated AFO in controlling idiopathic toe walking? Presented at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium. March 21-24. Atlanta.

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