BACKGROUND: Idiopathic toe walking (ITW) is a diagnosis of exclusion for 
children walking on their toes with no medical cause. This systematic review 
aimed to identify and evaluate the clinical utility, validity and reliability of 
the outcome measures and tools used to quantify lower limb changes within 
studies that included children with ITW.
METHODS: The following databases were searched from inception until March 2018: 
Ovid MEDLINE, EBESCO, Embase, CINAHL Plus, PubMed. Inclusion criteria were 
studies including children with ITW diagnosis, reporting use of measurement 
tools or methods describing lower limb characteristics, published in 
peer-reviewed journals, and in English. The relevant psychometric properties of 
measurement tools were extracted, and assessed for reported reliability and 
validity. Included articles were assessed for risk of bias using McMaster 
quality assessment tool. Results were descriptively synthesized and logistic 
regression used to determine associations between common assessments.
RESULTS: From 3164 retrieved studies, 37 full texts were screened and 27 full 
texts included. There were 27 different measurement tools described across joint 
range of motion measurement, gait analysis, electromyography, accelerometer, 
strength, neurological or radiology assessment. Interventional studies were more 
likely to report range of motion and gait analysis outcomes, than observational 
studies. Alvarez classification tool in conjunction with Vicon motion system 
appeared the contemporary choice for describing ITW gait. There was no 
significant association between the use of range of motion and gait analysis 
outcomes and any other outcome tool or assessment in all studies 
(p > 0.05).There was limited reliability and validity reporting for many outcome 
measures.
SIGNIFICANCE: This review highlighted that a consensus statement should be 
considered to guide clinicians and researchers in the choice of the most 
important outcome measures for this population. Having a standard set of 
measures will enable future treatment trials to collect similar measures thus 
allowing future systematic reviews to compare results.