Does external stimuli impact the gait of children with idiopathic toe walking

INTERVENTION: This project aims to investigate the acute impact on gait, of a number of treatment options including footwear, orthotics and whole body vibration stimulation to determine if any one intervention improves heel contact as measured on the GAITRite ('Registered Trademark) system. Four conditions will be tested‐ 1. Barefoot (no footwear) 2. Footwear 3. Orthotics and footwear 4. Whole body vibration, will be used and the immediate effect on gait will be measured. Each condition consists of two walking trials along the GaitRite mat, which is 8.3 metres in length. During recording, if the initial or final contact is a partial foot fall, due to the potential for the foot to strike the mat in a partial sensor area, this data will be excluded. All other contacts within the recording, including subsequent partial foot falls from each trial will be recorded for analysis. A one metre space will be provided at each end of the mat to allow the children to accelerate and decelerate as required. Conditions are as follows: Condition 1: After familiarisation, the child will be asked to remove their footwear and walk along the GAITRite('Registered Trademark) mat at their preferred pace. As children can control their idiopathic toe walking with concentration, the children will be asked to complete a verbal cogitative task at the same time. For example, they will be asked to perform a finger thumb apposition. Condition 2: The children will be placed in socks and the usual footwear worn for everyday athletic activities. The shoe will be laced securely by the research assistant and the children will be asked again to complete a cognitive task (finger thumb apposition) while walking along the GAITRite('Registered Trademark) mat. Condition 3: A custom made full length carbon fibre orthotic will be placed in the same shoes as those used in Condition 2. The child will then be asked to complete a cognitive task (finger thumb apposition) while walking along the GAITRite ('Registered Trademark) mat. Condition 4: The acute gait effect of whole body vibration will be measured after the administration of five sets of one minute vibration followed by one minute of rest to the child. The set frequency of 15hz will be used for each child while the child stands in a semi squat position on the machine. The child will be asked to walk along the GAITRite ('Registered Trademark) mat at 1 minute, 5 minute, 10 minute and 20 minutes after the 5 minutes of vibration. All children will be asked to again complete a cognitive task (finger thumb apposition) while walking to minimize their thought of changing their gait pattern. A randomization procedure by use of a Latin square design will be employed for the first three gait/external stimuli conditions (Condition 1, 2 & 3). Between each of these conditions, there is not anticipated to be a washout period and there will be 5 minutes between each testing period. Condition 4 will be conducted at the end of the randomized conditions as it involves whole body vibration and there is potential for residual effects. The randomisation will be conducted in the following pattern with participants ensuring each of the three conditions are randomised. As it is unknown what impact or wash out affect condition 4 may give, it has not been included in the randomisation. Condition 1, Condition 2, Condition 3, Condition 4 Condition 2, Condition 3, Condition 1, Condition 4 Condition 3, Condition 1, Condition 2, Condition 4 CONDITION: Idiopathic Toe Walking PRIMARY OUTCOME: GaitRite data produced with each intervention will include: ; ; 1. Heel contact pre and post interventions will be measured INCLUSION CRITERIA: ‐ Children diagnosed with ITW by multidisciplinary assessment within Toe Walking Clinic of Monash Childrens SECONDARY OUTCOME: Available ankle range of motion tested with the weight bearing lunge test Foot progression angle using the GaitRite system Step time using the GaitRite system Stride length using the GaitRite system Velocity using the GaitRite system ‐ Children between the ages of 4‐10 years of age ‐ Children who are able to heel toe walk on request and have a minimum of 15 degrees of ankle range of motion as measure on the weight bearing lunge