Background and Purpose: Best practice in physical therapy management of idiopathic toe walking (ITW) has not been established, and a valid system to measure toe walking gait is unavailable for clinicians. Purposes of this two-phase project were to 1) develop and test measurement properties of the gait event detector (GED), a device to measure the frequency of heel strike with gait in the natural environment; and 2) evaluate the effect of motor control intervention on gait in preschool age children diagnosed with ITW. Methods: Two designs were used: 1) Non-concurrent single system multiple baseline design (A, B) with two post-intervention measurements. Outcome measures were the GED and a parent visual analogue scale (VAS) estimate of percent heel-toe walking. 2) Repeated measures design. Outcome measures were the gross motor subtests of the Peabody Developmental Motor Scales (PDMS-2) and ankle dorsiflexion range of motion. Results: Gross motor skills, measured by the PDMS-2, were significantly increased at the immediate follow-up examinations but not at the 30-day follow-up examinations. Ankle dorsiflexion improved at the immediate follow-up examinations and improvement was maintained at the 30-day follow-up examinations. Gait results varied. Heel strike frequency, as measured by the GED in the intervention phase, showed a significant upward trend for 1 subject, slight upward trends for 3 subjects, and no change for 1 subject. Two subjects showed a 50% improvement in heel strike frequency between phases. Of these, one retained the slight upward trend of heel strike from the intervention phase at the 30-day follow-up session, signifying a gait change. No participant changed to a consistent heel-toe gait pattern with daily living based on parent perception from the VAS. Comparisons by individual subject of the longitudinal VAS estimates and GED measures on the same day showed correlations that ranged from 0.417 to 0.633. For the 5 subjects, the mean of the correlation scores was 0.057. Conclusions: Following motor control intervention for children diagnosed with ITW, gross motor skills improved and ankle ROM increased, but most gait measures did not meet a criterion of consistent, spontaneous heel-toe progression. Demonstration of marginal gait improvement may be due to inadequacy of the 1) measurement system or study design; 2) administration of intervention using pre-planned protocol and pre-set time period; or 3) match of motor control intervention to various musculoskeletal or neurological pathology associated with ITW. If structural stability within the foot has failed to develop, orthotic support may be needed to improve the base of support for persistent toe walking in preschool age children.
