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

Area of Science:

• Pediatrics
• Orthopedics
• Neurology

Background:

• Idiopathic toe-walking (ITW) has numerous treatment recommendations with questionable outcomes.
• Botulinum toxin A (BTX) is a potential treatment for ITW.

Purpose of the Study:

• To investigate if BTX improves the walking pattern in children with ITW.
• To assess ITW treatment effectiveness using 3-D gait analysis.

Main Methods:

• 15 children (5-13 years) with ITW received BTX (6 units/kg) and an exercise program.
• 3-D gait analysis was performed pre-treatment and at 3 weeks, 3, 6, and 12 months post-treatment.
• Parental perception and clinical classification of toe-walking severity were recorded.

Main Results:

• Gait analysis showed significant improvements in plantarflexion and dorsiflexion angles at all post-treatment points.
• After 12 months, 3/11 children ceased toe-walking, 4/11 decreased it, and 4/11 continued.
• Toe-walking severity classification improved in 9/14 children assessed at 6-12 months.

Conclusions:

• BTX injection with exercise improves the gait pattern in children with ITW.
• Complete cessation of toe-walking is an occasional outcome, not consistently achieved.