Idiopathic toe-walking: Does treatment alter the natural history?

Outcomes from observation or cast or surgical treatment of idiopathic toe-w alking were determined in 136 children. With patient-determined outcomes, f or the observation group,gait was normal in 6%, improved in 45%, and unchan ged in 49%. Physician-determined outcomes demonstrated normal gait in 12% o f children. Outcomes were similar in the cast group. With patient-determine d outcomes in the surgical group, 22% walked normally, 50% had improved, 26 % were unchanged, and 2% had deteriorated; with physician-determined outcom es, 37% walked normally. The natural history, determined from the observati on group, was for idiopathic toe-walking to persist, albeit with improvemen t in 50%. Cast treatment did not alter the natural history. Surgical treatm ent may influence the outcome, but indications for surgery need to be clari fied.