The utility of normative foot floor angle data in assessing toe-walking

•A normative set of foot floor angle data in children during gait was established.•The utility of normative foot floor angle in assessing toe-walking was studied.•Foot floor angle was significantly different between toe-walking and norms.•Foot floor angle was significantly improved following plantarflexor lengthening.•Floor interaction kinematics derived via ankle dorsiflexion angle can be misleading. Initial heel contact is an important attribute of gait, and failure to complete the heel rocker reduces gait stability. One common goal in treating toe-walking is to restore heel strike and prevent or reduce early heel rise. Foot floor angle (FFA) is a measure of toe-walking that is valuable for quantifying foot orientation at initial contact when using ankle dorsiflexion angle alone is misleading. However, no age-standardized FFA norms exist for clinical evaluation. Our objectives were to: (1) obtain normative FFA in typically developing children; and (2) examine its utility in the example of toe-walking secondary to unilateral cerebral palsy. Gait kinematics were acquired and FFA trajectories computed for 80 typically developing children (4–18 years). They were also obtained retrospectively from 11 children with toe-walking secondary to unilateral cerebral palsy (4–10 years), before and after operative intervention, and compared to 40 age-matched, typically developing children. FFA at initial contact was significantly different (P