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

Paolo Brasiliano; Martina Alvini; Eugenio Di Stanislao; Giuseppe Vannozzi; Giuseppe Di Rosa; Valentina Camomilla

doi:10.1016/j.heliyon.2022.e11021

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

Heliyon. 2022 Oct 12;8(10):e11021. doi: 10.1016/j.heliyon.2022.e11021. eCollection 2022 Oct.

Authors

Paolo Brasiliano^{1

2}, Martina Alvini^{1

3}, Eugenio Di Stanislao^{1

3}, Giuseppe Vannozzi^{1

2}, Giuseppe Di Rosa⁴, Valentina Camomilla^{1

2}

Affiliations

¹ Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Rome, Italy.
² Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy.
³ "ITOP SpA Officine Ortopediche", Via Prenestina Nuova 307/A, Area Industriale, 00036 Palestrina (RM), Italy.
⁴ Division of Pediatric Neurorehabilitation, "Ospedale Pediatrico Bambino Gesù", Rome, Italy.

Abstract

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 novel foot 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 a habituation 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. Gait spatiotemporal parameters, ankle kinetic and kinematic and rockers timing were analyzed. Lastly, ITW severity was 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 dorsiflexion angular excursion, range of motion, maximal dorsiflexor and plantarflexor moments together with maximal power absorption and production were all amplified.

Interpretation: While wearing it, A.Dyn.O.® limited gait deviations typical of ITW and improved ITW severity classification for most of the participants. These findings suggest that the use of A.Dyn.O.® may assist ITW treatment, preventing children from toe walking and thus limiting its side effects.

Keywords: Ankle kinematics; Ankle kinetics; ITW; Multi-segment foot model; Pediatric gait; Walking.