TOE WALKING

– main causes of toe walking are idiopathic toe walking and cerebral palsy
    – history may include continuous toe walking vs normal gait followed by delayed toe walking by age 2 yrs;
    – idiopathic toe walking is often caused by a congenitally short heelcord or an overactive calf muscle;
    – heel cord lengthening may be an option after age 3 if there is no improvement in symptoms;
    – in the report by JR Policy et al 2001, the authors investigated whether children with mild spastic diplegic CP could be
            differentiated from those with idiopathic toe-walking (ITW) based on an obligatory coactivation during voluntary
            contraction of the quadriceps or gastrocnemius;
            – 24 subjects participated in this study, 8 children with mild spastic diplegia CP, eight with ITW, and 8 age-matched controls;
            – measurements included passive range of motion and surface EMG recordings of the lateral quadriceps and lateral gastrocnemius;
            – EMG recordings were obtained during resisted knee extension with knee flexed 30°, isometric quadriceps contraction
                  with knee extended (quad set), active plantarflexion, and during gait;
            – range-of-motion values were not different between the CP and ITW subjects, with the exception of the
                  popliteal angle, which was greater in subjects with CP, with an overlap in values;
            – gait electromyography showed premature firing of gastrocnemius in swing in both groups of subjects compared with controls;
            – during resisted knee extension and quad set, the mean duration of gastrocnemius coactivation in subjects with CP was high: 86%
                  and 86% compared with 20% and 35% for the subjects with ITW and 0.4% and 3% for controls, respectively;
            – voluntary plantarflexion did not consistently elicit coactivation of the quadriceps;
            – results suggest that electromyographic testing of resisted knee extension and quad set to identify
                  gastrocnemius coactivation can help differentiate patients with mild CP from those with ITW;
            – ref: Electromyographic Test to Differentiate Mild Diplegic Cerebral Palsy and Idiopathic Toe-Walking
                  JF. Policy, M.D.   Journal of Pediatric Orthopedics 2001;21:784-789
    – in the report by M. Kogan et al 2001, the authors managed children with ITW using an outpatient percutaneous lengthening of
            the Achilles tendon, followed by placement of below-knee walking casts for 4 weeks;
            – authors reviewed 15 children who were treated for ITW with percutaneous Achilles tendon lengthening between 1993 and 1999;
            – 10 of the 15 patients could be contacted for a follow-up survey;
            – none of the parents stated that their child’s toe-walking had recurred;
            – all of the children were able to keep up with other children and did not notice any calf weakness;
            – 2 children had occasional Achilles tendinitis, which was relieved with antiinflammatory medications; 
       

ref:

  • Simplified Approach to Idiopathic Toe-Walking   Monica Kogan, M.D.   Journal of Pedicatric Orthopedics 2001;21:790-791
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