Cleveland Clinic Children's Outcomes

Toe walking is a diagnosis of exclusion given to children who continue to walk on their toes at an age when heel-toe gait should be established. In 2022, physical therapists at Cleveland Clinic Children’s Therapy Services began outcome collection on this specialty diagnosis. As part of this outcome collection, parents were asked what percentage of time their child spent walking on their toes. The average parent report of time spent toe walking was 74%. When asked about the time spent toe walking upon discharge from physical therapy, the parent-reported perception was 34.8%, a decrease of 39.2% from the initial baseline. The sample size was 48 patients.

Physical therapists clinically assess the extent of toe walking using a standardized fifty-foot walk test. The 50 Foot Walk Test (50-FWT) determines the percentage of toe walking performed by the child over a fifty foot distance with the use of an accelerometer for children 6 years and older. For greatest accuracy in children under 6 years, video analysis and observation can be used in the place of the accelerometer. At evaluation, the average toe walking percentage for the 50’ walk test was 46%. At discharge from physical therapy care, the average percentage was 17.8% showing a 28.3% decreased incidence of toe walking. Based on the child’s performance on the fifty-foot walk test, a toe walking severity grade from 1-6 is assigned. After physical therapy intervention, the overall severity grade improved by 1.2 from the initial evaluation. The sample size was 57 patients.