title: Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness?
abstract: BACKGROUND
  Idiopathic Toe Walking (ITW) is present in children older than 3 years of age still walking on their toes without signs of neurological, orthopaedic or psychiatric diseases. ITW has been estimated to occur in 7% to 24% of the childhood population. To study associations between Idiopathic Toe Walking (ITW) and decrease in range of joint motion of the ankle joint. To study associations between ITW (with stiff ankles) and stiffness in other joints, muscle strength and bone density.
  
  
  METHODS
  In a cross-sectional study, 362 healthy children, adolescents and young adults (mean age (sd): 14.2 (3.9) years) participated. Range of joint motion (ROM), muscle strength, anthropometrics sport activities and bone density were measured.
  
  
  RESULTS
  A prevalence of 12% of ITW was found. Nine percent had ITW and severely restricted ROM of the ankle joint. Children with ITW had three times higher chance of severe ROM restriction of the ankle joint. Participants with ITW and stiff ankle joints had a decreased ROM in other joints, whereas bone density and muscle strength were comparable.
  
  
  CONCLUSIONS
  ITW and a decrease in ankle joint ROM might be due to local stiffness. Differential etiological diagnosis should be considered.
authors.affiliation: Education of Physical Therapy, Amsterdam School of Health Professions, University of Applied Sciences (Hogeschool van Amsterdam), Amsterdam, The Netherlands. r.h.h.engelbert@hva.nl
authors.forename: Raoul
authors.initials: R
authors.lastname: Engelbert
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Gorter
authors.forename: Cuno
authors.initials: C
authors.lastname: Uiterwaal
authors.forename: Elise
authors.initials: E
authors.lastname: van de Putte
authors.forename: Paul
authors.initials: P
authors.lastname: Helders
mesh_terms: D000293:Adolescent; D000843:Ankle Joint / Q000503:physiopathology*; D015519:Bone Density / Q000502:physiology; D002648:Child; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D053580:Muscle Strength / Q000502:physiology; D009426:Netherlands; D016059:Range of Motion, Articular / Q000502:physiology*; D014034:Toes / Q000502:physiology*; D016138:Walking / Q000502:physiology*; D055815:Young Adult