Gait & posture · 2026
Reliability and utility of a novel classification scheme for gait deviations in children with persistent idiopathic toe walking.
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Childers Sancy, Brown Sean, Kephart Don, Bagley Anita, Kulkarni Vedant A, Davids Jon R
Аннотация
BACKGROUND: Neurotypical children in whom toe walking does not resolve spontaneously by school age are considered to have Persistent Idiopathic Toe Walking (ITWp). The Alvarez classification, the only existing tool for classifying ITWp, is imprecise, and external validity has not been established. A comprehensive classification scheme based upon gait deviations in children with ITWp has been developed to facilitate clinical decision making and outcomes assessment.
METHODS: A retrospective review was performed of subjects with ITWp, who were evaluated at a tertiary referral center by a standardized protocol including quantitative gait analysis. Sixty-five neurotypical children with ITWp were studied. Pre- and post-operative data were available for 26 of the 65 subjects (52 limbs). Cases were classified using the Alvarez classification and a novel Shriners Children's classification (SC-ITWp). Intra- and inter-observer reliability were determined for the SC-ITWp, as was utility (percentage classifiable) for both Alvarez and SC-ITWp (130 limbs, prior to intervention; 52 limbs following surgery to improve gait).
RESULTS: The SC-ITWp exhibited excellent reliability, with intra-rater agreement of 96.7% (weighted kappa = 0.98); and inter-rater agreement of 86.7% (weighted kappa = 0.93). The Alvarez classification exhibited poor utility, failing to classify 59 of 130 limbs (45%) prior to intervention, and 23 of 52 limbs (44%) following surgery. The SC-ITWp exhibited excellent utility, successfully classifying each limb discretely into one category.
CONCLUSIONS/SIGNIFICANCE: The SC-ITWp exhibited excellent reliability and utility in classifying the limbs of children with ITWp prior to interventions and following surgery to improve gait.
LEVEL OF EVIDENCE: Diagnostic, level II.
METHODS: A retrospective review was performed of subjects with ITWp, who were evaluated at a tertiary referral center by a standardized protocol including quantitative gait analysis. Sixty-five neurotypical children with ITWp were studied. Pre- and post-operative data were available for 26 of the 65 subjects (52 limbs). Cases were classified using the Alvarez classification and a novel Shriners Children's classification (SC-ITWp). Intra- and inter-observer reliability were determined for the SC-ITWp, as was utility (percentage classifiable) for both Alvarez and SC-ITWp (130 limbs, prior to intervention; 52 limbs following surgery to improve gait).
RESULTS: The SC-ITWp exhibited excellent reliability, with intra-rater agreement of 96.7% (weighted kappa = 0.98); and inter-rater agreement of 86.7% (weighted kappa = 0.93). The Alvarez classification exhibited poor utility, failing to classify 59 of 130 limbs (45%) prior to intervention, and 23 of 52 limbs (44%) following surgery. The SC-ITWp exhibited excellent utility, successfully classifying each limb discretely into one category.
CONCLUSIONS/SIGNIFICANCE: The SC-ITWp exhibited excellent reliability and utility in classifying the limbs of children with ITWp prior to interventions and following surgery to improve gait.
LEVEL OF EVIDENCE: Diagnostic, level II.