Abstract
When toe walking persists after the age of 2 years in the absence of any neurological or orthopedic abnormalities, it is referred to as idiopathic toe walking (ITW). When the plantar flexion persists, an equinus contracture can develop. There is inconsistency in the treatment of choice of this condition. A systematic review of observational studies comparing cast and operative treatment of children with ITW or equinus contracture was undertaken. Ten trials involving 298 participants were included. Ankle dorsiflexion increased 3.1° (median follow-up 3 years) in the cast treatment group and 14.2° (median follow-up 3.3 years) in the surgical group. No significant differences between groups were found in terms of persistent toe walking and complications after treatment. We have found favorable results in improvement of dorsiflexion for children treated by surgery. However, due to heterogeneity of patient groups, sample size and follow-up, no firm conclusions on a favorable role of surgery or cast treatment could be drawn in the treatment of ITW or equinus contracture.
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References
Kogan M, Smith J (2001) Simplified approach to idiopathic toe-walking. J Pediatr Orthop 21:790–791
Jahn J, Vasavada NA, McMulkin ML (2009) Calf muscle-tendon lengths before and after tendo-achilles lengthening and gastrocnemius lengthening for equinus in cerebral palsy and idiopathic toe walking. Gait Posture 29:612–617
Fox A, Deakin S, Pettigrew G, Paton R (2006) Serial casting in the treatment of idiopathic toe-walkers and review of the literature. Acta Orthop Belg 72:722–730
Hemo Y, Macdessi SJ, Pierce RA, Aiona MD, Sussman MD (2006) Outcome of patients after achilles tendon lengthening for treatment of idiopathic toe walking. J Pediatr Orthop 26:336–340
Stricker SJ, Angulo JC (1998) Idiopathic toe walking: a comparison of treatment methods. J Pediatr Orthop 18:289–293
McMulkin ML, Baird GO, Caskey PM, Ferguson RL (2006) Comprehensive outcomes of surgically treated idiopathic toe walkers. J Pediatr Orthop 26:606–611
Jacks LK, Michels DM, Smith BP, Koman LA, Shilt JA (2004) Clinical usefulness of botulinum toxin in the lower extremity. Foot Ankle Clin 9:339–348
Taussig G, Delouvée E (2001) Idiopathic toe walker child. Diagnosis and spontaneous evolution. Ann Readapt Med Phys 44:333–339
Engelbert R, Gorter JW, Uiterwaal C, van der Putte E, Helders P (2011) Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalized stiffness? BMC Musculoskeletal disord 2011:61
Eastwood DM, Menelaus MB, Dickens RV, Broughton NS, Cole WG (2009) Idiopathic toe-walking: does treatment alter the natural history? J Pediatr Orthop 9:47–49
Hirsch G, Wagner B (2004) The natural history of idiopathic toe-walking, a longterm follow-up of fourteen conservatively treated children. Acta Pediatr 93:196–199
Sala DA, Shulman LH, Kennedy RF, Grant AD, Chu ML (1999) Idiopathic toe-walking: a review. Dev Med Child Neurol 41:846–848
Sobel E, Caselli MA, Velez Z (1997) Effect of persistent toe walking on ankle equinus. Analysis of 60 idiopathic toe walkers. J Am Podiatr Med Assoc 87:17–22
Griffin PP, Wheelhouse WW, Shiavi R, Bass W (1977) Habitual toe-walkers. A clinical and electromyographic gait analysis. J Bone Joint Surg Am 59:97–101
Thevendran G, Sarraf KM, Patel NK, Sadri A, Rosenfeld P (2013) The ruptured achilles tendon: a current overview from biology of rupture to treatment. Musculoskeletal Surg 97:9–20
DiGiovanni CW, Kuo R, Tejwani N, Price R, Hansen ST, Cziernecki J, Sangeorzan BJ (2002) Isolated gastrocnemius tightness. J Bone Joint Surg Am 84-A:962–970
Grady JF, Kelly C (2010) Endoscopic gastrocnemius recession for treating equines in pediatric patients. Clin Orthop Relat Res 468:1033–1041
Solan MC, Kohls-Gatzoulis J, Stephens MM (2010) Idiopathic toe walking and contractures of the triceps surae. Foot Ankle Clin 15:297–307
Chen L, Greisberg J (2009) Achilles lengthening procedures. Foot Ankle Clin N Am 14:627–637
Engström P, Gutierrez-Farewik EM, Bartonek A, Tedroff K, Orefelt C, Haglund-Åkerlind Y (2010) Does botulinum toxin A improve the walking pattern in children with idiopathic toe-walking? J Child Orthop 4:301–308
DiGiovanni CW, Langer P (2007) The role of isolated gastrocnemius and combined achilles contractures in the flatfoot. Foot Ankle Clin 12:363–379
Phisitkul P (2012) Endoscopic surgery of the achilles tendon. Curr Rev Musculoskeletal Med 5:156–163
Brouwer B, Davidson LK, Olney SJ (2000) Serial casting in idiopathic toe-walkers and children with spastic cerebral palsy. J Pediatr Orthop 20:221–225
Brunt D, Woo R, Kim HD, Ko MS, Senesac C, Li S (2004) Effect of botulinum toxin type A on gait of children who are idiopathic toe-walkers. J Surg Orthop Adv 13:149–155
White JW (1943) Torsion of the achilles tendon: its surgical significance. Arch Surg 46:784–787
Babb A, Carlson WO (2008) Idiopathic toe-walking. S D Med 1:55–57
Stott NS, Walt SE, Lobb GA, Reynolds N, Nicol RO (2004) Treatment for idiopathic toe-walking: results at skeletal maturity. J Pediatr Orthop 24:63–69
van Bemmel AF, Bekerom MPJ, Verhart J, Vergroesen DA (2012) Preliminary results of 97 percutaneous gastrocnemius muscular lengthening operations in neurologically healthy children with an equinus contracture. Foot Ankle Surg 18:160–163
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van Bemmel, A.F., van de Graaf, V.A., van den Bekerom, M.P.J. et al. Outcome after conservative and operative treatment of children with idiopathic toe walking: a systematic review of literature. Musculoskelet Surg 98, 87–93 (2014). https://doi.org/10.1007/s12306-013-0309-5
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DOI: https://doi.org/10.1007/s12306-013-0309-5