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Stepping Towards Solutions: A Toe-walking Study at Shriners Children's

female patient during motion analysis center assessment

A young patient participates in a study in the motion analysis center.

Research is a core pillar of the Shriners Children’s mission. Our specialists believe in progress, innovation, and finding the best solutions for our patients. A multi-center research initiative is now underway aimed at enhancing the lives of children who face challenges with toe-walking.

Led by Jeremy Bauer, M.D., an orthopedic surgeon at Shriners Children's Portland, this study is a testament to our healthcare system’s commitment to providing the highest quality specialty pediatric orthopedic care. Specialists are enrolling children at eight Shriners Children’s locations across the country, and patients are invited to take part in this groundbreaking research opportunity.

two images of feet in casts

Casting is used to stretch a patient's calf muscle.

Understanding the Study

Toe-walking is common in toddlers who are learning to walk. While many outgrow it naturally, some require specialized care. Currently, two primary treatment options exist when toe-walking is due to muscle tightness: casting and surgery. For casting, the patient will typically undergo a series of stretching and casting treatments, gradually increasing their range of motion. It requires a longer commitment. Surgery addresses the calf muscle length in one procedure, but can be more involved than casting. The study aims to determine which approach leads to the most significant improvements in mobility and function.

Ted Sousa M.D., a fellowship-trained pediatric orthopedic surgeon, is the medical director of the motion analysis center at Shriners Children’s Spokane.

“There are a lot of questions with regards to toe walkers,” said Dr. Sousa. “We [physicians] all have our own preferred treatment protocol because that is how it has always been done, not necessarily because that is what research tells us what is the best method.”

How the Study Works

Patients who meet the strict criteria will participate in three comprehensive studies at our state-of-the-art motion analysis centers. A team of researchers will utilize a range of cutting-edge techniques in addition to motion analysis testing, including the use of wearable foot pressure sensors, to study the patient’s gait. Patients will perform some tasks at home. Participants will also undergo further tests and imaging, as specialists explore potential genetic links.

three images of feet

Various pictures display patients walking on their toes from different viewpoints.

Shriners Children’s will continue its recruitment efforts through 2024, followed by a thorough observation period until 2025. The goal is to involve 20 subjects from each location, with a goal of studying 160 total participants for the study.

Participating Locations:

Motion Analysis at Shriners Children's

Motion analysis can help us to understand the movement of children with neuromuscular-acquired or congenital disorders and develop an appropriate plan based on what we learn.
View Transcript
Fran Farley:
When a child has a condition that changes typical development and makes moving difficult, advanced diagnostic techniques may be necessary to understand fully what's causing the movement problem. Motion analysis can help us to understand the movement of children with neuromuscular-acquired or congenital disorders and develop an appropriate plan based on what we learn.

Speaker 2:
Shriners Children's has the largest motion analysis system in the world and utilizes computer-generated imagery or CGI just like in the movies. This type of in-depth gait analysis allows for a better understanding of how children walk and move, use their braces or walking aids and how we can improve their walking ability. Our team of orthopedic surgeons, physical therapists, orthotists and prosthetists meet to discuss the results of the gait analysis and create a personalized treatment plan for the patient.

Speaker 2:
From there, the MAC team determines the best plan of care going forward for the child, including recommendations for surgery, physical therapy and/or braces. The MAC provides services for a wide range of patients with diagnoses that include but are not limited to cerebral palsy, arthrogryposis, clubfoot, muscular dystrophy and spina bifida.

Speaker 2:
We start by attaching small wireless EMG sensors and reflective markers to the skin the same way you would apply a sticker. Then, we ask our patients to walk normally. As the patient moves, the 18 Vicon infrared cameras track their movements while four force plates record ground reaction forces. This information is translated into a 3D computer model of the patient walking. Our motion capture camera system is able to detect the motions of all of the joints, activity of all of the muscles and overall efficiency of walking that cannot be seen with the naked eye.

Fran Farley:
Once we analyze the information we collect, we'll partner with your child's Shriners care team to recommend a care plan, making changes that can reduce their pain or discomfort, and ultimately making it easier to do those things that are important to them. Through regular communication between our MAC locations, we share information, data and knowledge, which help all of the children we treat. A visit to the Shriners Children's Motion Analysis Center can help unravel the mystery and put your child on the path to reaching their goals and discovering their full potential.

Goals and Treatment Plans

Specialists will closely monitor how each participant walks and assess how their function and range of motion evolves with treatment. They are committed to helping every child reach their unique and personal goals. Doctors will also create customized treatment plans specific to the patients’ needs.

“Shriners Children’s conducts cutting-edge research. We are always looking to improve care,” said Dr. Sousa. “We are committed to doing research so we can deliver the best care for our patients.”

This study aims to create a brighter, more mobile future for children everywhere. Join us on this journey today!

If interested in more specific information about toe walking, motion analysis centers or research, patients and families should discuss it with their clinician.

Next Steps

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