Decision Trees: Linking Biomechanical and Developmental Characteristics of Preschool Idiopathic Toe Walkers: A Cross-Sectional Study

Background: Idiopathic Toe Walkers (ITW) show specific sensorimotor characteristics with different development, which requires foot, gait and developmental evaluation? Although algorithms facilitate their classification in clinical categories to select the best therapeutic options, decision trees would connect the diverse characteristics of preschool ITW and would help their early and comprehensive approach. The purpose of this study was to design decision trees and to propose their application in the ITW assessment and treatment. Methods: Fifty-six ITW's (aged 3-6 years) completed this cross-sectional study. The children underwent an orthopaedic foot evaluation and were subjects of a clinical ankle evaluation, a pedobarographic gait analysis and a developmental test - Cuestionario de Madurez Neuropsicológica Infantil (CUMANIN) -. Decision trees were developed with the studied variables, by calculating their quality value. Results: Different decision trees showed the interrelation between biomechanical and developmental variables in the studied ITW. Predictor variables were calcaneal pronation, passive ankle dorsiflexion, percentage of impulse of the forefoot, contact time of the hind foot, peak pressure under lateral area of the right hind foot and the CUMANIN Overall Development farthing. Conclusion: The decision trees obtained, with high values of quality, demonstrated that the older ITW had a top orthopaedic risk and an inferior level of development. Decision trees allow the integration of biomechanical and developmental variables in the assessment and treatment of the ITW, but their validation in a larger sample is necessary.