# Foot Contact Dynamics and Fall Risk among Children Diagnosed with Idiopathic Toe Walking  
[PERSON]  
1 Cream College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; [PERSON]ADDRESS] (R.S.); [PERSON]DRESS] (M.S.); [PERSON]IL_ADDRESS] (M.S.); [EMAIL_ADDRESS] (R.B.); [EMAIL_ADDRESS] (M.G.)  
[PERSON]  
1 Cream College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; [PERSON]ADDRESS] (R.S.); [PERSON]DRESS] (M.S.); [PERSON]IL_ADDRESS] (M.S.); [EMAIL_ADDRESS] (M.G.)  
[PERSON]  
3 School of Pharmacy, Chapman University, Orange, CA 92618, USA; [EMAIL_ADDRESS] (R.B.); [EMAIL_ADDRESS] (R.B.); [EMAIL_ADDRESS] (M.G.)  
[PERSON]  
3 School of Pharmacy, Chapman University, Orange, CA 92618, USA; [PERSON]DDRESS] (R.B.); [EMAIL_ADDRESS] (M.G.)  
[PERSON]  
4 Institute of Biomechanics, 8092 ETH Zurich, Switzerland; [PERSON]IL_ADDRESS] (R.B.)  
[PERSON]  
5 Howard R. Hughes College of Engineering, University of Nevada, Las Vegas, NV 89154, USA; [EMAIL_ADDRESS] (V.M.); [PERSON]] (M.T.)  
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short duration of loading) as well as development and remodeling in children (influenced by duration of loading and length of rest during toe walking) [9]. Previously, researchers have derived parameters using GRFs, such as peak forces, impulses, temporal events during the stance phase of gait to assess gait pathology [10]. Because toe walking is performed daily and frequently in this population, it is imperative to understand foot loading dynamics, slip and trip risk to intervene in cITW. A quantitative description of foot contact dynamics [11; 12; 13; 14] and gait assessment may be helpful in (i) revealing severity of ITW, (ii) establishing norms among cITW, and (iii) devise intervention strategies.  
It is well established that, during toe walking, increased plantarflexion can compromise gait stability and it is often associated with decreased walking speed and stride length [15; 16]. To maintain an upright posture, one has to stabilize the center of mass (COM) over the base of support. Stabilizing the COM over a small base of support when advancing their body forward during walking is challenging for cITW who are described to produce a bouncy gait with higher energy expenditures. Along with inefficient gait, the toe walkers have sensory processing and integration issues [17; 18]. Sensory integration is defined as the registration and modulation of input sensory signals (somatosensory, vision, and vestibular) to execute the movement. However, several studies have failed to demonstrate an enhanced sensory contribution to the muscle activity in toe walking children, and an alternative theory, which emphasizes altered central control as an adaptation to demands of muscle and joint mechanics, has been suggested [19; 20; 21]. It is not well known whether the toe walking observed among cITW is distinct as compared to the toe walking observed in healthy controls. It is also not known if angle of attack during foot initial contact (FIC) differs among cITW and will predispose them to falls. Given the dearth of evidence and inconsistent findings on toe walking among this particular population of ITW, this study's primary objective is to explore kinetic and gait differences during typical and toe walking and investigate how these influences fall risk. This study aims to examine how toe walking influences foot landing dynamics among cITW as compared to their healthy counter-parts and whether it predisposes them to trip risk and slip risk.