Idiopathic toe walking: A comparison of treatment methods

Eighty children with idiopathic toe walking (ITW) were examined 2-8 years ( average, 34 months) after initial presentation to compare outcomes [passive ankle dorsiflexion (DF) and parental satisfaction] after three treatment m odalities: observation, cast/brace treatment, or surgical triceps surae len gthening. Overall, 32% had a family history of ITW, 28% were born premature ly, and 16% had psychomotor delay. Forty-eight untreated patients showed li ttle change in passive ankle DF at final follow-up, and only 25% of parents were satisfied with the child's gait. Compared with untreated children, ca sting/bracing appeared to offer no significant improvement in ankle DF or p arental satisfaction. Surgical treatment was performed in 15 children with more severe equinus contractures. Triceps surae lengthening resulted in sig nificantly improved ankle DF and 67% parental satisfaction (p < 0.05). Toe walking may persist after all standard treatment methods, even in the absen ce of significant Achilles contracture.