Smart technology intervention to retrain gait in children with idiopathic toe walking

Approximately 5% of 6-year-old children demonstrate idiopathic toe walking (ITW). Children with ITW demonstrate limitations in balance and function.1,2 Currently, there are no interventions for ITW harnessing feedback during rehearsal of a heel strike in the natural environment. Could immediate and summary feedback in the natural environment retrain heel strike in children with ITW? Fourteen participants (mean age=10.3 years (SD 2.9), 10 M/4 F) diagnosed with ITW were evaluated prior to intervention (W0), following 12 weeks of intervention (W12) and 10 weeks-post intervention (P10) on parent report of toe walking (TW%), maximum dorsiflexion range (maxDF), sensory organization test (SOT), and 3D gait analysis. During a 12-week intervention phase, each child used a smart system which included a shoe insert with a haptic vibrator providing immediate feedback after toe strikes and a phone App which provided summary feedback for the user and parent on frequency of toe versus heel steps. A mixed effects linear model was used for analysis. Thirteen of 14 participants logged a mean of 229,491 steps (range 107,041-396,967 steps) over 57 mean days (range 30-81 days). One participant logged 3 days (6851 steps) use secondary to limitations in shoe fit. All 14 participants were included in the analysis. Parents reported % toe walking significantly decreased (p<.001), while MaxDF significantly increased (p=0.004). SOT total scores demonstrated a non-significant increase (p=0.11). Significant differences were observed in the gait analysis between measurements at W0 and W12 with no significant difference between W12 and P10, including increase toe clearance (p<0.001), increased ankle dorsiflexion at heel strike (p=0.006), increased dorsiflexion during swing (p=0.005), and an increase in height of the lateral 5th metatarsal compared to the heel (p=.009). No significant differences were found in stride length, stride time or percent stance over the 3 measurement times (Table 1).Download : Download high-res image (212KB)Download : Download full-size image These results suggest that a 12-week intervention with a smart system providing immediate and summary feedback in the natural environment has potential to retrain the ankle motion during gait in children with ITW. These results are strengthened by the fact that significant differences were observed in measurements at the ankle with no other changes in gait characteristics. In addition, the participant who had limited wear, demonstrated no improvements over the intervention. Our work demonstrates initial success through use of a smart insole among children diagnosed with ITW.