A new approach from the analysis of dynamic stability
Gwerder et al. (2025) have just published a study that opens up many connections: “Assessing dynamic stability in children with idiopathic toe walking during overground walking” in Clinical Biomechanics.
Idiopathic toe walking (ITW) remains a clinical challenge. Although it is commonly associated with ankle stiffness, muscle shortening, imbalance, and sensorimotor alterations, this new study proposes looking beyond the joint and observing the body in motion: how does the child organize movement in order not to fall?
Swiss researchers analyzed 35 children with ITW and compared them to 20 typically developing children using 3D gait analysis. They introduced two key measures to assess dynamic stability:
- Margin of Stability (MoS): measures how close the child’s center of mass is to moving outside their base of support.
- Whole-Body Angular Momentum (WBAM): reflects how much the body rotates during walking.
Key findings:
- Children with ITW show a significantly shorter anterior margin of stability, indicating a “falling-forward” strategy.
- They also exhibit higher angular momentum in the coronal plane, suggesting more side-to-side movements and less postural control.
- No significant differences were found in walking speed or conventional spatiotemporal parameters.
What does this mean clinically?
It seems that children with ITW don’t just walk “weird” because of an orthopedic issue. Their pattern appears to be an adaptation to maintain forward movement, likely because they haven’t yet developed mature central control of gait.
This pattern resembles that of very young children: stiff trunk, less rotation, short steps, and greater reliance on primitive strategies.
Once again, we are seeing neurosensorimotor and neurodevelopmental aspects in these children.
What can we associate this with?
A very interesting clinical aspect of children with toe walking is the alteration of the plantar grasp circuit. In strength, endurance, and control testing, they struggle to activate their toe flexors.
Moreover, in balance tests, it is often observed that the toes seem unresponsive.
If anterior imbalance is managed by toe flexor activity (stand up and try it yourself), could this study be showing a relationship between the two phenomena?
Implications for physiotherapy:
- Interventions focused solely on stretching the triceps surae or using orthoses may fail because they don’t address the real problem: ineffective motor organization.
- Evaluating dynamic stability with MoS and WBAM could offer new tools for diagnosis, treatment monitoring, and the design of more comprehensive intervention programs.
- It may be valuable to systematically include toe observation during balance tests and to implement specific tests of motor control circuits in the toes.
Conclusions:
Toe walking might be more of an adaptive strategy than just a simple biomechanical problem.
Understanding how a child maintains balance while walking allows us to rethink our therapeutic goals: not just to correct the symptom, but to train a new way of controlling movement.
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