title: The 3-Step Pyramid Insole Treatment Concept for Idiopathic Toe Walking.
abstract: The idiopathic toe walking (ITW) gait pattern is characterized in children for walking since the beginning on their first steps on the forefoot; however, these children are able to support their whole foot on the ground. ITW can only be diagnosed in the absence of any orthopaedic or neurological condition known to cause tiptoe walking. The aim of this article is to review other references and provide an outline of the different treatment options, including the 3-step-pyramid insole treatment concept for children with ITW.
  
  
  METHODS
  Fifty-four articles in English, German, and Spanish were reviewed. There were comparative, retrospective or case studies, classifications or literature reviews and they were divided according with these categories. All the literature reviewed was published between 2000 and 2015.
  
  
  RESULTS
  There are some studies that proved the 3-step pyramid insole treatment concept as an effective option compared with other therapeutic modalities such as physical therapy, casting, botolinum toxin type A (BTX), and surgery.
  
  
  CONCLUSIONS
  There is a wide spectrum regarding the therapeutic options for children with ITW, from physical therapy to surgery options. However, any of these treatment modalities have been reported to be fully successful for the whole toe walking population. Some procedures seem to have achieved faster results or seem to have longer lasting effects. Therefore, further research on the causes of ITW is recommended.
  
  
  METHODS
  Therapeutic, Level II: Systematic review, prospective, comparative.
authors.affiliation: Praxis Pomarino, Hamburg, Germany (DP, JR, AP).|Department for Pediatric and Neuro-orthopaedics, Hannover Medical School, Hannover, Germany (SM).
authors.forename: David
authors.initials: D
authors.lastname: Pomarino
authors.affiliation: Praxis Pomarino, Hamburg, Germany (DP, JR, AP).|Department for Pediatric and Neuro-orthopaedics, Hannover Medical School, Hannover, Germany (SM).
authors.forename: Juliana
authors.initials: J
authors.lastname: Ramírez-Llamas
authors.affiliation: Praxis Pomarino, Hamburg, Germany (DP, JR, AP).|Department for Pediatric and Neuro-orthopaedics, Hannover Medical School, Hannover, Germany (SM).
authors.forename: Stephan
authors.initials: S
authors.lastname: Martin
authors.affiliation: Praxis Pomarino, Hamburg, Germany (DP, JR, AP).|Department for Pediatric and Neuro-orthopaedics, Hannover Medical School, Hannover, Germany (SM).
authors.forename: Andrea
authors.initials: A
authors.lastname: Pomarino
keywords: age-related problems; diagnostic and therapeutic techniques; forefoot; midfoot; pediatric podiatry; toe; toe walking