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Idiopathic toe walkers: Do they need surgery?

Alice Bonnefoy-Mazure1,2, Marys Revaz1,2, Camille Leroquais3

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|September 30, 2025
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Summary

Idiopathic toe walking (ITW) patients show improved gait parameters after surgery or conservative treatment, but do not fully achieve healthy child gait patterns. Both treatments enhance gait quality over time.

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Area of Science:

  • Orthopedics
  • Pediatric Gait Analysis
  • Biomechanical Engineering

Background:

  • Idiopathic toe walking (ITW) is a common pediatric condition with no established treatment consensus.
  • Equinus deformity significantly impacts ITW, necessitating consideration of conservative or surgical interventions.

Purpose of the Study:

  • To evaluate gait parameter evolution in ITW patients undergoing surgical versus conservative treatment.
  • To compare gait parameters between treated ITW patients and a control group of asymptomatic children.

Main Methods:

  • Retrospective comparative study (Level III) of 16 surgically treated and 13 conservatively treated ITW patients.
  • Clinical gait analysis (CGA) before and after treatment assessed ankle rocker, peak ankle power, and passive dorsiflexion.
  • Paired and unpaired t-tests analyzed differences between treatments and with controls.

Main Results:

  • Both surgical and conservative ITW treatments significantly improved gait parameters.
  • The surgical group demonstrated a significant improvement in passive ankle dorsiflexion.
  • Post-treatment, the surgical group exhibited greater passive dorsiflexion and ankle power compared to the conservative group, though both remained below asymptomatic levels.

Conclusions:

  • Gait quality in ITW patients improves with both surgical and conservative treatments.
  • Neither treatment fully restores gait parameters to those of healthy, asymptomatic children.