Application of the International Classification of Functioning, Disability, and Health (ICF) During Physical Therapy Management of a Child with Idiopathic Toe Walking, a Case Study

Background & Purpose: The support for the conceptual application of the International Classification of Functioning, Disability, and Health (ICF) to clinical practice is evident from the literature, and yet, it challenges the practicability in clinical practice.
Idiopathic Toe Walking (ITW) is a diagnosis of exclusion characterized by a persistent toe–toe gait pattern after three years of age. It is often difficult to properly reach a clinical judgment on the mechanisms underlying ITW with many possible structural and functional involvements. Furthermore, the course of treatment for these patients can be challenging.
The purpose of this case study is to describe a clinical decision-making process for PT management of a child with ITW using the ICF framework.

Case Description: A 9-year-old female, with ITW, participated in this study. The child was born as an identical twin after an uneventful pregnancy with uncomplicated spontaneous delivery. No post-natal complications arose. There were no delays in attaining motor milestones, according to the caregiver. Toe walking was not better explained by neurological or musculoskeletal conditions.
The parent interview and examination findings were classified into the ICF components. In the ICF component of body functions and structures, the child demonstrated reduced triceps surae and anterior tibialis strength, reduced ankle dorsiflexion ROM, increased lumbar lordosis, and impaired motor coordination and balance.
Under the ICF component of activities and participation, the child scored 11/24 on the Pediatric Modified (DGI) displaying significant fall risk. The child also demonstrated limitations in walking long distances, stair climbing, ambulation on uneven surfaces, and running, jumping, and hoping skills, which clearly restricted the child’s ability to keep up with peers.
A plan of care to address impairments, activity limitations, and participation restrictions was developed.

Outcomes: Using the ICF framework was useful to organize the patient’s examination information, interpret examination findings, identify problems, and guide the decisions needed for the PT management. as well as involve others who may be able to provide care for the patient from a different perspective.
The relationships between the patient’s most significant activity limitations, and impaired body functions and structures were evaluated to reach a clinical judgment on the mechanisms underlying the toe-toe gait pattern.
The patient’s results were encouraging, supporting the hypothesis that ITW can be managed through the conservative treatment

Discussion: This case report illustrates the benefit of using ICF in the clinical decision-making process for PT management of a child with ITW.
ICF can be applied in each of the five elements of the patient/client management model from examination to intervention. allowing for a comprehensive assessment, goal setting, and intervention planning. The Guide and the ICF are complementary. As such integration between both of them aids in the clinical decision-making process and at the same time helps in the identification of appropriate strategies for positive treatment outcomes.