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

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.

Keywords: ITW; idiopathic toe walking; nonsurgical treatment; serial casting.

Fig. 1

Cohen’s d effect size. The effects calculated between the measurement time before serial cast treatment (V1) and after six months of follow-up (V3). There are strong effects at d ≥ 0.8.

Fig. 2

Primary outcome. Box plots with medians, interquartile range and range for the normalized plantar heel force (log F_Norm) in the control group (R) without an idiopathic toe walking (ITW) gait and for the ITW group (V) at the measurement time points before serial cast treatment (V1), after serial cast treatment (V2) and after six months of follow-up (V3).

Fig. 3

Secondary outcomes. Box plots with medians, interquartile range and range for: a) the normalized compound action potential of the medial head of the gastrocnemius (EMG_Norm); b) the angle between the base and sole of the foot (angle_base); c) the angle in the upper ankle joint (angle_upper ankle joint); d) instability of the body’s centre of gravity on the transverse plane (R_CoG); e) displacement instability of the knee joint on the sagittal plane (dx_knee). R represents the healthy control group and V the idiopathic toe walking group at the three different measurement time points, before serial cast treatment (V1), after serial cast treatment (V2) and after six months of follow-up (V3).