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Surgical Outcomes for Severe Idiopathic Toe Walkers
David E Westberry1,2, Ashley M Carpenter1,2, Addison Brandt3
1Pediatric Orthopedic Surgery, Motion Analysis Laboratory, Shriners Hospitals for Children.
Journal of Pediatric Orthopedics
|January 6, 2021
Summary
Surgical intervention for severe idiopathic toe walking (ITW) can be effective. Zone III plantar flexor lengthening surgery demonstrated more successful outcomes in resolving ITW compared to Zone II procedures.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomechanics
Background:
- Idiopathic toe walking (ITW) is a diagnosis of exclusion with varying severity.
- Conservative treatments are common, but surgery is reserved for severe or refractory cases.
- Previous outcome studies are limited by mixed case severity.
Purpose of the Study:
- To review surgical outcomes in severe ITW patients who failed conservative treatment.
- To compare outcomes between Zone II and Zone III plantar flexor lengthening procedures.
Main Methods:
- Retrospective case series of 26 patients (46 extremities) undergoing surgical management for severe ITW.
- Procedures included Zone II or Zone III plantar flexor lengthening.
- Data collected included clinical, radiographic, and motion analysis preoperatively and at 1-year follow-up.
Main Results:
- Zone III lengthening (21 extremities) showed 100% decreased severity of ITW.
- Zone II lengthening (25 extremities) showed 88% decreased severity of ITW.
- Six extremities (all Zone II initially) required further treatment.
Conclusions:
- Surgical intervention is beneficial for severe ITW or ITW unresponsive to conservative care.
- Zone III plantar flexor lengthening yielded more successful outcomes in resolving toe walking.
