Does botulinum toxin A improve the walking pattern in children with idiopathic toe-walking?

Abstract

Background: Numerous recommendations have been made for treating idiopathic toe-walking (ITW), but the treatment results have been questioned. The purpose of this study was to investigate whether botulinum toxin A (BTX) improves the walking pattern in ITW as examined with 3-D gait analysis.

Participants and methods: A consecutive series of 15 children (aged 5-13 years) were enrolled in the study. The children underwent a 3-D gait analysis prior to treatment with a total of 6 units/kg bodyweight Botox(®) in the calf muscles and an exercise program. The gait analysis was repeated 3 weeks and 3, 6, and 12 months after treatment. A classification of toe-walking severity was made before treatment and after 12 months. The parents rated the perceived amount of toe-walking prior to treatment and 6 and 12 months after treatment.

Results: Eleven children completed the 12-month follow-up. The gait analysis results displayed a significant improvement, indicating decreased plantarflexion angle at initial contact and during swing phase and increased dorsiflexion angle during midstance at all post-treatment testing instances. According to the parents' perception of toe-walking, 3/11 children followed for 12 months had ceased toe-walking completely, 4/11 decreased toe-walking, and 4/11 continued toe-walking. After 6-12 months, the toe-walking severity classification improved in 9 of the 14 children for whom data could be assessed.

Conclusions: A single injection of BTX in combination with an exercise program can improve the walking pattern in children with ITW seen at gait analysis, but the obvious goal of ceasing toe-walking is only occasionally reached.

Keywords: 3-D gait analysis; Botulinum toxin A; Gait analysis; Habitual toe-walking; Idiopathic toe-walking; Toe-walking.

Fig. 1

Ankle dorsiflexion angles throughout the gait cycle for three right strides during the evaluation period (before treatment and 3 weeks and 3, 6, and 12 months after treatment) in two participants, shown together with the laboratory pediatric control database of 23 children with typical motor development, aged 5–14 years (mean ± 1 SD, in blue). The parents of the participant in a (subject 2) reported that toe-walking had ceased, and the parents of the participant in b (subject 1) reported that toe-walking had continued