Introduction: Idiopathic toe walking (ITW) is a common pediatric diagnosis. Serial casting, a common treatment used for an ankle equinus contracture, may not be appropriate for all children. This pilot study investigated whether carbon fiber two-pull solid ankle-foot orthoses (CTP-AFOs) would have similar outcomes as serial casting in the treatment of children with a diagnosis of ITW and ankle equinus contracture.
Materials and Methods: Children with ITW (n = 35) were randomized to receive CTP-AFOs or serial casting. Assessments were at initial, posttreatment, and 4-month follow-up with therapy protocols until posttreatment.
Results: There was no statistical difference in active (<0.001) and passive (<0.001) dorsiflexion range of motion, the Observa- tional Gait Scale (<0.001), the Pediatric Reach Test (<0.01) popliteal range of motion (<0.001), strength in dorsiflexion (<0.001) and plantarflexion (0.21), and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (0.31). Both groups demonstrated significant improvement over time with therapeutic intervention performed by a physical therapist.
Conclusions: Carbon fiber two-pull solid ankle-foot orthoses are a noninferior alternative to serial casting in a population with ITW and ankle equinus contracture. Therapeutic interventions for treatment of ITW and ankle equinus contracture have demonstrated improvements in motor outcomes. (J Prosthet Orthot. 2022;34:140–151)
Idiopathic toe walking (ITW) gait pattern is a prevalent diagnosis in the pediatric population, with studies finding approximately 5% of children documented as having ITW.Children who demonstrate persistent ITW may have limitations in range of motion in the biarticular gastrocnemius, leading to an ankle equinus contracture. Ankle equinus contracture may predispose this population for pain, injury, delay in developmental skills, or pathology through their lifespan. Interventions focused on ankle equinus contracture may lower risk for the aforementioned impairments later in life.