Recurrent toe walking in pediatric orthopedic patients: idiopathic versus concomitant sensory processing disorders

The study aimed to compare rates of recurrent toe walking following operative intervention between idiopathic toe walkers and toe walkers with autism or a similar sensory processing disorder (SPD). A retrospective review of all patients at a single institution who underwent surgical treatment for toe walking over a 12-year period was conducted. Children with neuromuscular disorders, congenital deformities, prior foot/ankle surgery, and those not managed with an isolated triceps surae procedure were excluded. The remaining patients were divided into those with idiopathic toe walking (ITW group) and toe walking associated with autism spectrum/SPDs (SPD group). Toe walking recurrence and need for additional surgery for recurrence were compared between cohorts. A total of 106 patients met inclusion criteria; 29 (27%) had a SPD and 77 comprised the ITW group. There were no differences between groups in follow-up length (average 1.2 years; P = 0.08) or type of index surgery ( P = 0.48). SPD patients had significantly more male patients (76 vs. 48%; P = 0.01) and were younger at their index surgery (8.5 vs. 10 years; P = 0.03). SPD patients had significantly higher rates of recurrence than ITW patients (24 vs. 5%; P = 0.009) at an average of 2.6 years following the index procedure. Multivariate regression analysis revealed that an underlying SPD was an independent predictor of recurrence ( P = 0.018, odds ratio = 7.5, 95% confidence interval: 1.5-45.2). Autism spectrum disorder/SPDs confer over a seven-fold increased risk of recurrence following the surgical treatment of toe walking when compared with idiopathic toe walkers. The level of evidence is therapeutic level III.