Investigating the Relationship Between Sensory Processing, Pain and Toe Walking Gait: A Survey Study

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Abstract
Aim: This study aimed to examine sensory processing patterns, the frequency and impact of parent‐reported pain in children who toe walk across a range of diagnoses using validated caregiver‐report tools. Methods: An online cross‐sectional survey was distributed internationally between July 2024 and March 2025. Parents of children who toe walk aged 3–14 years, regardless of diagnosis, completed the Short Sensory Profile (SSP) and the Child Activity Limitations Interview‐9 (CALI‐9). Results: The survey collected responses from 176 parents of 187 children with toe walking gait. Sensory processing challenges were frequently reported, particularly in children with autism spectrum disorder (98%). Nearly half (48% of 187) of children were reported to experience pain, most frequently in the feet/ankles, lower legs, and hips/thighs. Most parents (94%) and their child's medical professional (81%) attributed their child's pain to toe walking. Parents of children experiencing pain described significantly greater limitations in activities such as sports (OR 3.10, p < 0.001), running (OR 3.46, p < 0.001), and social participation (OR 2.43, p < 0.001). Conclusion: Sensory processing differences and pain were frequently reported among children who toe walk in this sample. Routine assessment of sensory processing and pain in clinical practice may guide targeted interventions to improve participation, function, and quality of life.

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