Efficacy of serial casting protocols in idiopathic toe-walking

Area of Science:

• Orthopedics
• Pediatric Physical Therapy

Background:

• Idiopathic toe-walking (ITW) is a diagnosis of exclusion characterized by a persistent inability to heel strike.
• Decreased ankle range of motion (ROM) is often associated with ITW, prompting interventions to improve dorsiflexion.
• Serial casting is a common treatment for ITW, but optimal casting duration remains debated.

Purpose of the Study:

• To compare the effectiveness of one-week versus two-week serial casting intervals on ankle ROM in children with ITW.
• To assess the recurrence rate of ITW following different serial casting durations.

Main Methods:

• Retrospective study of 86 pediatric patients diagnosed with ITW.
• Patients were divided into two groups: weekly casting (N=29) and two-week casting (N=57).
• Ankle ROM was measured at baseline, 2 weeks, 4 weeks, and final cast removal; statistical analyses included t-tests and regression models.

Main Results:

• After adjusting for baseline ROM, one-week casting intervals showed significantly greater improvement in ROM compared to two-week intervals at both 2 weeks (10.6° vs 7.5°, p<0.001) and final measurement (13.4° vs 9.8°, p<0.001).
• The rate of ITW recurrence was not significantly different between the one-week and two-week casting groups.

Conclusions:

• Weekly serial casting appears more effective in improving ankle dorsiflexion ROM in children with ITW compared to two-week intervals.
• The findings suggest that shorter casting intervals may lead to better ROM outcomes without increasing recurrence risk.