The management of toe walking is controversial, and only limited data are available regarding direct comparisons of different treatment modalities. Therefore, the physician’s first decision point is whether the toe-walking gait should be treated or whether simple observation should be recommended. Observation is appropriate for a toddler with idiopathic toe walking (ITW) who has recently begun to walk and is without fixed contractures. Fazil Say Alla Turca Pdf To Word on this page. In many children, this condition is only a temporary habit, and a normal heel-toe gait eventually develops. [, ] The patient should be monitored at 6-month intervals. If progressive heel-cord contractures are detected or if the pattern does not resolve spontaneously by age 3 years, treatment can be considered. If treatment is offered, nonoperative management (see Medical Therapy) is always considered before operative management (see Surgical Therapy).

Serial plaster-of-paris casting as described by Brand is recognized as an effective technique for regaining proximal interphalangeal joint extension. However, the inability of the serial cast to “purchase” the full length of the proximal phalanx decreases the length of the proximal lever arm available to extend the joint. LeafBridge Serial Casting Clinic. Serial casting is a specialized technique used at LeafBridge in conjunction with therapy to provide increased range of joint motion. RESEARCH REPORT Assessment Protocol for Serial Casting After Botulinum Toxin A Injections to Treat Equinus Gait Barbara Kelly, PT, BSc, Marilyn J. MacKay-Lyons, PT.

If nonoperative modalities are not successful and surgery is chosen, surgical options range from simple heel-cord tenotomy or gastrocnemius-fascia lengthening to multiple-muscle lengthening within the lower extremity. The final surgical approach depends heavily on the underlying pathology of the toe walking. There are instances in which each of the modalities that have been devised for the treatment of toe walking is inappropriate or frankly contraindicated.

These instances are discussed below, along with the details of treatment options. Stretching must use the patient's body weight; the lower-extremity muscles are too powerful to allow effective passive stretching by parents or therapists.

In one technique, the child is stood with the forefoot elevated on a small block so that the heel may drop downward. The parents steady the child and add gentle pressure to the stretching process. In a second technique, the patient leans forward against a counter, with feet together and pointed straight forward, knees straight, and hips extended. Progressive stretch is accomplished by increasing the distance from the counter.

Williams et al studied the effect of applying whole-body vibration on heel strike, spatial and temporal gait parameters, and ankle ROM in children with ITW. [] Preintervention ankle ROM was compared with ROM immediately after and 20 minutes after intervention.

Increases in heel contact and ankle ROM were observed immediately after intervention but were not sustained 20 minutes later. The gait improvement from whole-body vibration could be due to a rapid increase in ankle ROM or to a neuromodulation response. This potential treatment modality presents a nonrestrictive form of treatment, though it is unfortunate that the changes achieved were not sustained for a significant amount of time. Serial casting is another nonoperative technique for stretching the Achilles tendon. [] The child is placed in a below-the-knee plaster or fiberglass cast while the knee is flexed and the foot is dorsiflexed.

This is most easily done with the child prone and with an assistant pushing gently downward on the forefoot. Once the cast has set, the gastrocnemius component stretches further as the knee extends. These casts are changed weekly or biweekly to progressively increase the range of dorsiflexion. Between cast changes, the child can walk with the use of cast shoes. For toe walking due to muscle spasticity, stretching alone is ineffective. [] Serial casting can be used to lengthen the Achilles tendon, but the contracture recurs rapidly unless the patient is maintained in an AFO.