Surgery may be best treatment for idiopathic toe-walking in pediatric patients
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Key takeaways:
- Surgery was linked with higher rates of toe-walking resolution vs. casting and physical therapy or orthoses.
- Surgery was linked with better range of motion vs. casting and physical therapy or orthoses.
SAN FRANCISCO — Surgery may be the best treatment for moderate to severe contractures in pediatric patients who are idiopathic toe-walkers, according to results presented here.
“Resolution was highest with surgery. Range of motion also improved the most with surgery,” Emily Dodwell, MD, FAAOS, pediatric orthopedic surgeon at Hospital for Special Surgery, said in her presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “However, casting may still be considered as an initial treatment for toe-walking with contracture because it is less invasive.”
Dodwell and colleagues performed a retrospective cohort study that analyzed data from 82 patients (172 limbs) aged 4.5 to 11 years who had habitual toe-walking with or without contracture, or with congenital contracture.
Researchers categorized patients into one of the following treatment three arms: observation physical therapy or orthoses, serial casting or surgery. The level of contracture in each patient was categorized as severe (less than 0° dorsiflexion), moderate (0° to 10° dorsiflexion) or mild (greater than 10° dorsiflexion).
Outcome measures included the proportion of patients with resolved toe-walking, as well as preoperative and postoperative range of motion.
Overall, Dodwell said patients with severe contractures had a 58% improvement with casting and an 86% improvement with surgery. In moderate cases, there was a 42% improvement with casting and a 78% improvement with surgery. In mild cases, 17% improved spontaneously and 50% improved with casting. None of the patients with mild contractures underwent surgery, according to Dodwell.
Dodwell said patients who had observation physical therapy or orthoses experienced an average decrease in range motion of 2°. She noted that patients who had casting experienced an average improvement of 9° in their range of motion, while patients who had surgery experienced an average improvement of almost 20° in their range of motion.
Dodwell concluded, “We feel a prospective cohort study documenting resolution rates, improvements in range of motion and incorporating patient-reported outcomes will be helpful to either confirm or refute our findings.”
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Dodwell E, et al. Paper 330. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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