Idiopathic Toe-Walking Position Sensation

Gait Disorder, Sensorimotor Clinical Trial

Official title:

The Relationship Between Two-point Discrimination and Position Perception in Children Who Have Idiopathic Toe Walk

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05692791
• Other study ID #: AEUnivers
• Status: Not yet recruiting
• Start date: March 30, 2024
• Est. completion date: May 30, 2024

Study information

• Verified date: February 2024
• Source: Kirsehir Ahi Evran Universitesi
• Contact: Ömer Faruk Özçelep, Msc
• Phone: +90 531 946 3799
• Email: omer.ozcelep[@]ahievran.edu.tr
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The aim of this study is to investigate the effect of plantar two-point discrimination on hip-knee-ankle position sense in children with toe walking.The main questions it aims to answer are:

• Are two-point discrimination and light pressure sensation in the plantar region affected in children with idiopathic toe gait?

• Does the two-point discrimination in the plantar in general and the heel in particular affect the position sense of the hip-knee and ankle?

Description:

Children who tend to walk on toes after they should have developed a heel-toe gait are diagnosed with idiopathic toe walking (ITW).Cerebral palsy, muscular dystrophy, and orthopaedic problems such congenital talipes equinus are some of the diseases that are frequently linked to a toe-walking gait. A diagnosis of ITW is made when there is no physical or medical cause for the absence of a heel strike. Five percent of healthy children are estimated to have ITW, and boys are more likely than girls to be affected. Reduced ankle range of motion is prevalent symptom in children with ITW. Since ITW often manifests as symmetrical tiptoe walking in children, reports showing a comparable bilateral reduction in ankle range of motion at both lower limbs indicate the symmetrical character of this gait type. Lower vibration perception thresholds, a tendency to be left-handed, and noticeable variations in sensory seeking and modulation scores are all characteristics of children with an ITW gait.

The small fibers that innervate the cutaneous receptors (such as Merkel's cell, Pacinian corpuscles, Meissner's corpuscles, and Ruffini endings in the skin) are more crucial for postural control than the large fibers that innervate the major muscle spindles and the Golgi tendon organs. Standing balance control is more dependent on Merkel's cells and Ruffini endings (slow adapting receptors), which are in charge of touch and pressure sensitivity, than it is on Meissner's and Pacinian corpuscles (rapid adapting receptors), which are in charge of vibrotactile sensitivity.Additionally, it has been demonstrated that tactile sensation in the foot sole affects the activity of the tibialis anterior muscle as well as the regulation of gait pattern at lower limb joints. These investigations support the notion that cutaneous feeling is crucial for preserving postural and gait stability.The literature states that plantar pressure and sensory changes have disruptive effects on postural control.The aim of this study is to investigate the effect of plantar two-point discrimination on hip-knee-ankle position sense in children with toe walking.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 16
• Est. completion date: May 30, 2024
• Est. primary completion date: May 30, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 3 Years to 10 Years

Eligibility

Inclusion Criteria:

• Having idiopathic toe walking diagnosis

Exclusion Criteria:

• Having another known neuromuscular disease

Related Conditions & MeSH terms

• Gait Disorder, Sensorimotor
• Gait Disorders, Neurologic

Intervention

Diagnostic Test:
• Two-point Discrimination Test
Two-point discrimination (2PD) is the ability to discern that two nearby objects touching the skin are truly two distinct points, not one. It is often tested with two sharp points during a neurological examination and is assumed to reflect how finely innervated an area of skin is.
• Semmes-Weinstein monofilament test
Semmes-Weinstein monofilament test is used to assess light touch sensations.

Locations

Country	Name	City	State
Turkey	Ahi Evran University	Kirsehir

Sponsors (1)

Lead Sponsor	Collaborator
Kirsehir Ahi Evran Universitesi

Country where clinical trial is conducted

Turkey, 

References & Publications (2)

Silva PG, Jones A, Araujo PM, Natour J. Assessment of light touch sensation in the hands of systemic sclerosis patients. Clinics (Sao Paulo). 2014 Sep;69(9):585-8. doi: 10.6061/clinics/2014(09)02. — View Citation

Westberry DE, Davids JR, Davis RB, de Morais Filho MC. Idiopathic toe walking: a kinematic and kinetic profile. J Pediatr Orthop. 2008 Apr-May;28(3):352-8. doi: 10.1097/BPO.0b013e318168d996. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Hip-Knee-Ankle Joint Position Sense	Position the body segment being tested and then passively position the individual's joint in space. Hold the lateral surfaces of the limb to minimize cues from touch and pressure sensations.; Move the body segment into a position and either have the patient maintain the position or assist the patient in maintaining the position if needed.; Have the patient duplicate the position with the opposite extremity. The procedure is repeated enough times to conclude if joint position sense is intact or impaired. A suggested minimum number of trials is five per joint.	15 weeks