Functional Bandaging in Children with Idiopathic Toe Walking

BACKGROUND:Idiopathic toe walking (ITW) is a persistent gait pattern with no known etiology, which is characterized as premature heel-rise or no-heel contact. The aim of this study was to investigate the effects of functional bandaging in children with ITW on heel-contact during stance phase and gait quality. METHODS:Nineteen children, 4-16 years of age with ITW (mean{plus minus}SD: 7.36{plus minus}3.16) and ten age-matched healthy pairs (mean{plus minus}SD: 7.30{plus minus}2) were included in the study. Elastic adhesive bandages were applied to children with ITW to assist with dorsiflexion. Before bandaging (T0), immediately after initial bandaging (T1), and one week later with the same bandage (T2), the initial contact, loading response, and mid-stance sub-phases of gait were analyzed using light-pressure sensors and the Edinburgh Visual Gait Score (EVGS). Ten age-matched children with typical gait participated for comparison in T0. The data was analyzed by using Friedman and Wilcoxon signed-rank tests for within-group comparison and Mann-Whitney U tests for between-group comparison. RESULTS:In T0, for the ITW group, no heel contact was observed during stance. In T1, all the participants achieved heel contact at initial contact and loading response; and 56.8%, at mid-stance. In T2, all the heels continued contact at initial contact and loading response; and 54.3%, at mid-stance. The EVGS significantly improved. The Friedman test showed that there were noteworthy improvements between T0-T1 and T0-T2 in VBOGA and EVGS (p < 0.001), although no difference was found between T1-T2 in VBOGA (p = 0,913) and EVGS (p = 0,450). CONCLUSIONS:In this study, for ITW children, dorsiflexion assistive functional bandaging was an effective tool to help achieving heel contact on the ground and improve walking quality for a short period of time after the application. Further studies with longer follow-ups and larger sample sizes are required to confirm the long duration therapeutic effects of this promising functional bandaging.