Bischof F.1, Aduc T.2
1University of the Witwatersrand, Orthopaedic Surgery, Johannesburg, South Africa, 2Private Practice, Johannesburg, South Africa
Background: Idiopathic toe walking (ITW) is the persistence of a tip toe gait in the absence of a neurological condition. The cause is unknown. The approach to the management of the condition is varied and includes observation, surgery, casting, Botulinum Toxin A and physiotherapy. The choice of management is controversial.
Purpose: The purpose of this study was to evaluate the outcome of a combined intervention (Botulinum Toxin A, casting and a home exercise program) in an eight year old child with a habitual toe walking pattern. He had started walking on his toes from the age of 13 months when he began to walk independently.
Methods: Botulinum toxin A (total dosage 400 iu) was injected into his gastrocnemius and hamstrings bilaterally under anaesthesia. Below knee plaster casts were worn for two weeks. A home exercise program was demonstrated by the physiotherapist. Measurements were taken pre intervention, and at 7 weeks and 6 months post intervention. Outcome measures included ankle dorsiflexion, popliteal angle, scoring of gait using the observational gait scale and parent report.
Results: Passive ankle dorsiflexion improved from 90-15 degrees bilaterally to 90 degrees bilaterally at 7 weeks and this was maintained at the 6 month follow up. The popliteal angle improved from 30 degrees bilaterally to 10 degrees bilaterally at 7 weeks, but returned to 30 degrees bilaterally at the 6 month follow up. A perfect score for the observational gait scale is 22 on each side. His score was 16 on the right and 14 on the left before the intervention.This had improved to 20 on each side at the 6 month follow up. His parents reported that he occasionally walked on his toes when tired.
Conclusion(s): A combined regimen of Botulinum Toxin A, casting and a home exercise program was successful in correcting habitual toe walking in this child.
Implications: Habitual toe walking requires a multi-pronged approach to intervention
Funding acknowledgements: Self funded
Topic: Paediatrics
Ethics approval: Ethics approval not required
All authors, affiliations and abstracts have been published as submitted.
