Idiopathic toe walkers: Conservative or surgical treatments?

Idiopathic toe walking (ITW) refers to a condition where a person persistently walks on their toes after the age of 5 years, without any underlying neurological or orthopedic abnormalities (1-3). ITW can lead to various issues such as pain in the feet and/or calfs, skeletal deformities,and increased risk of falls (4). The treatments for ITW depend on the severity of the equinus (toe walking) and may include conservative such as casts or orthoses, or surgical treatments such as gastrocnemius recession or tendo-achilles lengthening. However, there is currently no consensus on the optimal treatment for patients with ITW (5, 6). The aims of this study were: 1) to observe gait parameters evolution for a group of patients with surgery and conservative treatment; 2) to compare these parameters for a group of matched patients with surgery and without; 3) to compare these parameters with a group of asymptomatic children. ITW patients with surgical or conservative treatment and with at least one clinical gait analysis (CGA) before and after treatment were selected in the database of the Willy Taillard Kinesiology laboratory. Gait parameters (first ankle rocker, value and time of maximal dorsiflexion during stance, ratio between the ankle maximal moments, peak of ankle power generation, Ankle Gait Variable Score and GPS without hip rotation) were computed, and clinical parameters (ankle passive dorsiflexion with extended and flexed knee) were extracted). Paired and Unpaired t-tests were performed to analyse differences between the two CGA for each group of treatment, between groups of treatment (only for matched patients in terms of ankle passive dorsiflexion at the first CGA) and with asymptomatic children. Sixteen ITW patients were treated surgically with a mean age at baseline of 8.6 y and a follow-up time of 2.1 y. Thirteen ITW patients were treated conservatively with mean age at baseline of 6.5 y and a follow-up time of 3.0 y. Only the surgery group had a significant improvement in ankle passive dorsiflexion. Both groups significantly improved their gait and clinical parameters. Out of the 10 patients in each treatment group who had similar ankle passive dorsiflexion at the first CGA, the surgery group showed significantly greater improvement in passive dorsiflexion and ankle power at the second CGA. In comparison to asymptomatic children, both treatment groups had significantly lower parameters. The study findings suggest that while surgical treatment for ITW resulted in improved gait outcomes, it did not result in a complete return to normal gait. Moreover, conservative treatment also resulted in improved gait outcomes. Therefore, surgical treatments should be reserved for children with severe ITW, calf muscle contracture, or complaints about pain. Further randomized controlled studies are needed with a larger sample and a longer follow-up to confirm these findings.