Evaluating the efficacy of interventions for idiopathic toe-walking in children. Research proposal for prospective DPhil student (3-year project)

Project No: NDORMS 2024/08
Intake: 2024

Background

Idiopathic toe walking (ITW) is a common, exclusionary diagnosis to describe children with minimal or no heel contact to the ground during walking. There are many gaps in the existing understanding of ITW, including the causes and long-term impact.

A further gap in the existing research is the best treatment for children with ITW. Most treatments, both conservative and invasive, aim to reduce the plantarflexion contractures which prevent children from walking on their heels. However, there is a significant paucity in the existing evidence to support any treatment modality, with only one study - which investigated conservative treatments - included in the analysis of a recent Cochrane review.

Research Proposed

The primary research study proposed is a pilot study evaluating the efficacy of surgical intervention for ITW. In this prospective, observational cohort study patients undergoing surgical lengthening of their plantarflexors to treat ITW will be evaluated. The primary outcome measure is the Oxford Foot and Ankle Questionnaire for Children. Secondary outcome measures include health state, ankle endurance, joint movements and gait pattern using three-dimensional gait analysis and patient satisfaction.

The ultimate goal of this study is to gain baseline data and evaluate feasibility to design future clinical trials evaluating treatments for ITW.

This project is endorsed by the British Society of Children’s Orthopaedic Surgeons, who are in part funding this study. Great Ormond Street Young Person’s advisory group have provided some insight into this research area and the ethical approval for this work is currently being sought.

With the pilot study as the backbone of the DPhil research, candidates are invited to explore the field in any areas of their interest; for example, investigating the biomechanics of ITW gait in further depth, or the efficacy of other treatment methods including non-operative interventions. Researching such a common problem like ITW with far-ranging physical and psychosocial implications gives the prospective student opportunities for quantitative and qualitative research, with the ultimate goal to improve the lives of children and young people.

Selected relevant recent publications

Current Management of Idiopathic Toe-Walking Gait in Children and Young People in the UK: A Cross- Sectional Survey to Reflect Physiotherapists’ and Surgeons’ Perspective. DOI 10.29011/2575-9760.001688
Using surface markers to describe the kinematics of the medial longitudinal arch. DOI 10.1016/j.gaitpost.2023.03.016
Multi-segment foot models and their use in clinical populations. DOI 10.1016/j.gaitpost.2019.01.022

Comparison of the hindfoot axes of a multi-segment foot model to the underlying bony anatomy. DOI 10.1016/j.jbiomech.2019.06.006
Kinematic differences between neutral and flat feet with and without symptoms as measured by the Oxford foot model. DOI 10.1016/j.gaitpost.2018.10.015

Training

The Botnar Research Centre plays host to the University of Oxford's Institute of Musculoskeletal Sciences, which enables and encourages research and education into the causes of musculoskeletal disease and their treatment. Training will be provided in techniques including three-dimensional gait analysis, musculoskeletal modelling and computer programming. Students will also be required to attend regular seminars within the Department and those relevant in the wider University.

Students will be expected to present data regularly in Departmental seminars for the ROAM group and to attend external conferences to present their research globally, with limited financial support from the Department.

Students will have access to various courses run by the Medical Sciences Division Skills Training Team and other Departments. All students are required to attend a 2-day Statistical and Experimental Design course at NDORMS and run by the IT department (information will be provided once accepted to the programme).

How to Apply

It is recommended that, in the first instance, you contact the relevant supervisor(s) and the Graduate Studies Office (graduate.studies@ndorms.ox.ac.uk), who will be able to advise you of the essential requirements. Interested applicants should have, or expect to obtain, a first or upper second-class BSc degree or equivalent in a relevant subject and will also need to provide evidence of English language competence (where applicable). The application guide and form is found online and the D.Phil will commence in October 2024.

Applications should be made to the following programme using the specified course code.

D.Phil in Musculoskeletal Sciences (course code: RD_ML2)

For further information, please visit http://www.ox.ac.uk/admissions/graduate/applying-to-oxford.