Validation of Parental Reports in Assessing Idiopathic Toe Walking Using Quantitative In-Shoe Device Measurements.

Background: Toe walking is prevalent among children, affecting 5% to 24% of the pediatric population. Clinicians rely on parental reports of frequency of toe walking to guide clinical decision making and outcomes assessment. However, recall accuracy and differing environments challenge the reliability of parental reports. This study aims to validate parental reports against quantitative in-shoe device measurements (NURVV/RUN).

Methods: Twenty children with persistent idiopathic toe walking (ITWp) (mean age: 9.6y; 13 males, 7 females) from 8 pediatric orthopaedic specialty care sites participated in this multicenter study. Parents assessed toe walking frequency using a 6-point scale, while children wore NURVV/RUN insoles for 8 hours/day over 7 days. Insole sensors recorded foot strike patterns (rearfoot, midfoot, and forefoot), which were classified using the same severity scale. Agreement between parental reports and NURVV data was assessed using weighted Kappa statistics (P<0.05).

Results: Before intervention, children with ITWp exhibited daily walking patterns: 61.7% forefoot, 15.3% midfoot, and 22.8% hindfoot contact. Agreement analysis showed substantial agreement (k=0.688, P<0.001) for combined forefoot and midfoot contacts and fair agreement (k=0.381, P<0.005) for isolated forefoot contact.

Conclusion: Parental reports of toe walking prevalence in their children are relatively accurate, supporting their use in clinical management. However, quantitative in-shoe devices provide a more objective and quantitative understanding of ITWp frequency and have the potential to guide clinical decision-making and outcomes assessment children with ITWp.

Level Of Evidence: Level II-diagnostic study. See instructions to authors for a complete description of levels of evidence.