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Non-invasive serial casting to treat idiopathic toe walking in an 18-month old child
Emidio E Pistilli1, Tracy Rice2, Paola Pergami3
1Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV, USA Center for Cardiovascular and Respiratory Sciences, West Virginia University School of Medicine, Morgantown, WV, USA.
Insights
Serial casting effectively treated idiopathic toe walking in an 18-month-old child, improving ankle flexibility and establishing a heel-toe gait. This non-invasive approach offers a promising alternative to surgery for young children.
Area of Science:
- Pediatric orthopedics
- Neurology
Background:
- Idiopathic toe walking (ITW) is persistent toe walking without diagnosed neuromuscular disease.
- Treatment options include observation, physical therapy, serial casting, and surgery.
Observation:
- A case report details a non-invasive serial casting protocol for an 18-month-old child with severe ITW.
- Neurological examination confirmed the diagnosis of idiopathic toe walking.
Findings:
- Four weeks of serial casting increased passive ankle dorsiflexion to 10°.
- A heel-toe walking gait was established and maintained at 3, 7, and 12 months post-treatment.
Implications:
- Non-invasive serial casting is effective for treating ITW in very young children.
- Early intervention may prevent the need for invasive surgical procedures and associated risks.
Background:
Idiopathic toe walking is characterized by persistent toe walking in the absence of clinically diagnosed neuromuscular disease. Treatment options in children diagnosed with idiopathic toe walking include: observation, physical therapy, serial casting, or Achilles tendon (heel cord) lengthening surgery.
Objective:
In this case report, we present a non-invasive serial casting protocol to treat severe and persistent toe walking in an 18-month old child, diagnosed as an idiopathic toe walker following neurological examination.
Methods:
A series of below knee casts was used to provide a consistent stretch to the plantar flexor muscles. Upon removal of each set of casts, passive range of motion at the ankles was measured with a goniometer.
Results:
Four sets of casts, each lasting approximately one week, increased passive ankle dorsiflexion to 10° of neutral and established a heel-toe walking gait. Improvements in ankle range of motion and gait were maintained upon repeated examinations at 3, 7, and 12 months post-casting.
Conclusions:
These results demonstrate that non-invasive procedures, such as serial casting, can be successful in very young children diagnosed as idiopathic toe walkers. Early identification and intervention for this diagnosis may eliminate the need for invasive surgeries and associated risks in this population.
