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Related Experiment Video

Updated: Jan 6, 2026

Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder
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Interventions for idiopathic toe walking.

Antoni J Caserta1, Verity Pacey, Michael Fahey

  • 1Child and Family Team, Monash Health, 140-154 Sladen St, Cranbourne, Victoria, Australia, 3977.

The Cochrane Database of Systematic Reviews
|October 7, 2019
PubMed
Summary
This summary is machine-generated.

This review found very low-certainty evidence that botulinum toxin type A (BTX) with serial casting may not significantly improve idiopathic toe walking (ITW) in children. More research is needed to confirm the effectiveness of ITW treatments.

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Area of Science:

  • Pediatrics
  • Orthopedics
  • Rehabilitation Medicine

Background:

  • Idiopathic toe walking (ITW) is diagnosed in healthy children who continue to walk on their toes beyond the typical age for heel-toe gait.
  • Treatment options range from conservative interventions for young children to surgical procedures for older children with limited ankle dorsiflexion.
  • A systematic review is crucial to evaluate the evidence for various ITW interventions and guide clinical and family decision-making.

Purpose of the Study:

  • To systematically assess the effects of conservative and surgical interventions for idiopathic toe walking (ITW) in children.
  • To evaluate impacts on gait normalization, ankle range of motion, pain, recurrence rates, and adverse effects.
  • To identify gaps in the current research base for ITW treatments.

Main Methods:

  • A comprehensive search of multiple databases (e.g., Cochrane, MEDLINE, Embase) and clinical trial registries was conducted.
  • Included randomized or quasi-randomized trials involving participants diagnosed with ITW, regardless of age or ankle dorsiflexion limitation.
  • Primary outcome was improvement in toe walking (defined as >50% heel-toe walking); secondary outcomes included range of motion, pain, recurrence, and adverse events.

Main Results:

  • Only one randomized controlled trial with 47 participants met the inclusion criteria for detailed analysis.
  • The study compared serial casting with serial casting plus botulinum toxin type A (BTX), finding very low-certainty evidence for improvement in ITW gait.
  • No significant differences were observed in ankle dorsiflexion or recurrence rates; adverse events were minor and did not affect adherence.

Conclusions:

  • The certainty of evidence from the included study is too low to draw definitive conclusions about the effectiveness of BTX combined with serial casting for ITW.
  • Limited outcome data from other studies on BTX, footwear, exercises, and orthoses prevent assessment of their effects.
  • Significant deficits exist in the research base for idiopathic toe walking interventions, necessitating further high-quality trials.