Serial ankle casts for patients with idiopathic toe walking: Effects on functional gait parameters

• Published in: Journal of children's orthopaedics Vol. 13; no. 2; pp. 147 - 154
• Main Authors: Thielemann, F., Rockstroh, G., Mehrholz, J., Druschel, C.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.04.2019; Sage Publications Ltd; The British Editorial Society of Bone & Joint Surgery
• Subjects: Ankle; Fingers & toes; Gait; Kinematics; Neuromuscular diseases; Original Clinical; Orthopedics; Pediatrics; Physical therapy; Software; Surgery; Walking; Austria; Germany; serial casting; nonsurgical treatment; ITW; idiopathic toe walking
• ISSN: 1863-2521; 1863-2548
• DOI: 10.1302/1863-2548.13.180183

Abstract Purpose The aim of the present study was to investigate the functional effects on gait parameters of serial ankle casts for patients with idiopathic toe walking (ITW), in comparison with an unremarkable control group. Methods A prospective trial with a pre-test–post-test control group design included ten patients with ITW and ten healthy matched children. Children with ITW underwent serial casting to stretch the plantar flexors, with two 14-day periods with walking plaster casts set at the maximum available ankle dorsiflexion. Both groups were assessed clinically and using a functional gait analysis before and after serial casting, as well as at a six-month follow-up visit. Results The normalized plantar heel force increased from 5% pre-interventionally to 79% at the follow-up. The upper ankle-joint angle and the base angle also demonstrated significant changes. Normalized compound action potentials of the medial heads of the gastrocnemius were reduced by 70%. None of these parameters demonstrated any significant differences at the follow-up examination in comparison with the healthy control group. Variations in the displacement of the knee joint on the sagittal plane and of the center of gravity in the transverse plane did not show any significant differences in comparison with the control group. Conclusion The reduction of muscle tone and lengthening of the ankle plantar flexors led to persistent increased active ankle dorsiflexion with significant long-term improvement of functional kinematic parameters. No significant difference in the gait analysis was found between the ITW group and healthy children six months after treatment. Level of Evidence Level II - Therapeutic