# Foot Contact Dynamics and Fall Risk among Children Diagnosed with Idiopathic Toe Walking
## 4 Discussion
\begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline  & & **Toe Walking** & \multicolumn{4}{c}{**Typical Walking**} \\ \hline \hline  & & **Push-Off** & **Swing** & **FIC** & **Push-Off** & **Swing** & **FIC** \\ \hline \multirow{3}{*}{Control [Degrees]} & Ankle & \(-\)26.8 \(\pm\) 12.4 & \(-\)34.2 \(\pm\) 8.0 & \(-\)27.6 \(\pm\) 10.3 & 1.8 \(\pm\) 5.9 & \(-\)15.4 \(\pm\) 6.4 & 0.2 \(\pm\) 5.5 \\ \cline{2-8}  & Knee & 5.1 \(\pm\) 9.8 & 25.6 \(\pm\) 6.4 & 4.4 \(\pm\) 8.7 & 1.5 \(\pm\) 7.2 & 33.5 \(\pm\) 6.6 & 1.7 \(\pm\) 7.4 \\ \cline{2-8}  & Hip & 38.0 \(\pm\) 14.5 & 3.0 \(\pm\) 12.9 & 36.3 \(\pm\) 13.6 & 37.6 \(\pm\) 12.8 & 2.2 \(\pm\) 10.7 & 37.6 \(\pm\) 11.3 \\ \hline \multirow{3}{*}{ITW [Degrees]} & Ankle & \(-\)34.6 \(\pm\) 10.8 & \(-\)39.7 \(\pm\) 10.3 & \(-\)33.5 \(\pm\) 9.8 & \(-\)9.9 \(\pm\) 7.1 & \(-\)19.1 \(\pm\) 9.8 & \(-\)8.7 \(\pm\) 6.8 \\ \cline{2-8}  & Knee & 1.4 \(\pm\) 8.4 & 22.1 \(\pm\) 5.7 & 1.8 \(\pm\) 7.5 & 0.8 \(\pm\) 5.0 & 32.2 \(\pm\) 6.0 & 1.8 \(\pm\) 5.1 \\ \cline{2-8}  & Hip & 41.3 \(\pm\) 15.2 & 4.5 \(\pm\) 11.0 & 42.7 \(\pm\) 13.8 & 38.7 \(\pm\) 11.8 & 8.7 \(\pm\) 12.2 & 40.0 \(\pm\) 11.7 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Mean \(\pm\) SD of Joint angles during push-off, swing and FIC for ankle, knee and hip for ITW and control with different walking types. recommended. Scientific knowledge lacks an objective assessment of ITW foot contact dynamics and how these influence slip and trip risk during walking as compared to age-matched healthy counterparts. In this study, we investigated ITW gait using kinetics and gait kinematics when walking in two different styles: (i) their usual or typical walking style and (ii) toe walking. Some advantages of using GRF in toe walking analysis include ease of use, non-invasive, portable forceplates, and they can be easily installed in clinical walking environments. The assessment of gait characteristics and risk of falls among cITW is challenging, since children can alter their gait while under observation in clinical laboratory. This makes gait analysis among ITW difficult with gait and fall risk underdiagnosed and underappreciated. To our knowledge, this is the first study investigating typical and toe walking differences among ITW and the age matched control population. The major findings are adaptations of cITW during push-off by producing significantly higher push-off rates and force impulses. They are also found to exhibit significantly higher joint angles at the knee level during the push-off. This adaptation at the knee joint through increased flexion angles during typical walking could be an extra burden on cITW and induce muscle fatigue and increase the risk of injuries. Earlier researchers have used a kinematic analysis of ankle range of motion to differentiate ITW from CP [16, 37, 38, 39]. We found that both ITW and control groups demonstrated significantly lower joint angles at loading, mid-stance, and push-off during toe walking (Table 1), suggesting rigidity at the lower extremity. The stiffening behavior and freezing the degree of freedom at the lower extremity joints could jeopardize gait stability and increase the chances of severe falls and injuries [40, 41]. It was also found that foot segment angles at FIC were in the position of dorsiflexion for control typical walking, whereas it was at plantar flexion angle for cITW similar to toe walking (Figure 6). The magnitude of plantarflexion angles during FIC could serve as a score of ITW severity. We also found that stride length was significantly longer during typical walking among both groups and shorter during toe walking. The reduced stride length indicates that toe walking is more restrictive with a limited degree of freedom to both groups and it will redistribute plantar foot pressures [42] to maintain COM over a smaller base of support.