Association between idiopathic toe walking and gross motor skill development in early childhood

Abstract

The objective of this cross-sectional study was to establish the association between idiopathic toe walking and gross motor skill acquisition among children aged 4 to 10 years. Data were collected between July 2025 and January 2026 from the Physical Therapy and Rehabilitation Department at the University of Lahore Teaching Hospital (ULTH) and the Physical Therapy Department at Sehat Medical Complex (SMC), Hanjarwal, Lahore, Pakistan, after obtaining informed written consent. Children with idiopathic toe walking (ITW) were recruited through non-probability convenience sampling (n = 29). ITW characteristics were assessed using the Toe Walking Tool (TWT), while gross motor performance was measured using the locomotor subtest of the Test of Gross Motor Development, Third Edition (TGMD-3). Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 26, applying descriptive statistics and the Spearman rank correlation. A statistically significant moderate negative correlation was found between toe-walking frequency and gross motor development scores (r = -0.529, p = 0.003). Children with higher severity of toe walking demonstrated lower gross motor performance, and significant differences in motor scores were observed across severity groups. Idiopathic toe walking is significantly associated with reduced gross motor skill development; increased frequency and severity of toe walking are linked with poorer motor performance, highlighting the importance of early identification and physiotherapy intervention.