Effects of wearing a foot orthosis on ankle function in children with idiopathic toe walking during gait

Background: Idiopathic toe walking (ITW) is a gait deviation characterized by forefoot contact with the ground,possibly enhancing the risk of falling and causing Achilles’ tendon shortening and psychological discomfort.Between possible treatments, foot orthosis may limit ITW when worn. With these premises, the effects of a novelfoot orthosis (A.Dyn.O.®) on ankle function were analyzed in children with ITW during gait.Methods: Twenty-one children were recruited in the study after ITW diagnosis. At follow-up assessment after ahabituation period of at least two weeks, participants walked in barefoot condition and while wearing A.Dyn.O.®.Kinetics and kinematics were derived from a multi-segment foot model using an optoelectronic system. Gaitspatiotemporal parameters, ankle kinetic and kinematic and rockers timing were analyzed. Lastly, ITW severitywas classified according to Alvarez classification. Differences between conditions were verified with paired t-test.Statistical parametric mapping was used to evaluate differences in the entire kinematic and kinetic waveforms.Findings: Wearing A.Dyn.O.®, step cadence was reduced, step length, stance phase and stride duration increased;physiological heel rocker was present, thus postponing the timing of ankle and forefoot rockers; ankle dorsiflexionangular excursion, range of motion, maximal dorsiflexor and plantarflexor moments together with maximal powerabsorption and production were all amplified.Interpretation: While wearing it, A.Dyn.O.® limited gait deviations typical of ITW and improved ITW severityclassification for most of the participants. These findings suggest that the use of A.Dyn.O.® may assist ITWtreatment, preventing children from toe walking and thus limiting its side effects.