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Conservative treatment of idiopathic toe walking
Gait & Posture 49S (2016) 192
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P52 presented in PS02: Poster teaser: Children (non-CP)
Conservative treatment of idiopathic toe walking Sergio Lerma Lara 1,2,*, Ignacio Martı´nez Caballero 1, Teresa Martı´n Lorenzo 1, Beatriz Moral Saiz 1, Estela Maris Parra Mussin 1, A´lvaro Pe´rez-Somarriba Moreno 1, Ana Ramı´rez Barraga´n 1 1 2
Hospital Infantil Universitario Nin˜o Jesu´s, Madrid, Spain Health Sciences Faculty, Physical Therapy Department, CSEU La Salle, UAM, Madrid, Spain
Introduction: Idiopathic toe walking (ITW) is a common paediatric gait disorder characterised by excessive plantar flexion during the gait cycle [1]. Conservative treatment is part of the global management and must be considered as the first step of the treatment algorithm [2]. The aim of this study is to evaluate the clinical impact of a home-based exercise program associated with the use of a night splint (AFO) for managing gait problems in children with ITW. Research question: Is the conservative treatment an option to consider for clinical management of gait disorders in children with ITW? Methods: A kinematic comparative study was developed in order to check long-term effects of the treatment on gait parameters. Follow-ups were conducted at 6, 12, and 18 months. 29 children with ITW and 15 healthy children. The proposed treatment was a home-based exercise program in combination with the use of a night splint for 12 months. Results: Several kinematic values improved and a normalization of gait kinematics was observed at the 18-month follow-up. We found statistically significant differences for gait kinematics (A1, A3, A5 and GDI) (Table 1).
* Corresponding author. E-mail address: [email protected] (S.L. Lara). http://dx.doi.org/10.1016/j.gaitpost.2016.07.246 0966-6362/
Table 1 Ankle kinematic values. Baseline and follow-up of the outcome measures. Outcome Base line measures
6 months F-UP
12 months F-UP
18 months F-UP
P value
A1 A3 A5 GDI
( )10.4 8.7 4.7 8.8 ( )4.3 6.1 91.4 4.2
( )5.5 4.1 10.4 3.8 ( )1.1 4.1 94.3 4.7
( )2.9 4.1 12.7 3.4 0.4 3.9 97.6 4.1
<0.0001 <0.0001 <0.0001 <0.0001
( )15.5 10.2 0.8 13.3 ( )6.4 9.5 88 3.3
Discussion: 3D gait analysis is an assessment tool for gait disorders and for long-term follow-up of children with ITW. Our home-based exercise associated with a night splint showed good results for gait disorders treatment in children with ITW. Similar results were reported using casting or botulinum toxin injections [3]. According to our results surgical management must be taken in consideration just for conservative treatment failures. References [1] Engelbert R. BMC Musculoskelet. Disord. 2011;21(12):61. [2] Clark E. Pediatr. Phys. Ther. 2010;22(4):417–26. [3] Engstro¨m P. J. Bone Joint Surg. Am. 2013;95:400–7.
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P52 presented in PS02: Poster teaser: Children (non-CP)
Conservative treatment of idiopathic toe walking Sergio Lerma Lara 1,2,*, Ignacio Martı´nez Caballero 1, Teresa Martı´n Lorenzo 1, Beatriz Moral Saiz 1, Estela Maris Parra Mussin 1, A´lvaro Pe´rez-Somarriba Moreno 1, Ana Ramı´rez Barraga´n 1 1 2
Hospital Infantil Universitario Nin˜o Jesu´s, Madrid, Spain Health Sciences Faculty, Physical Therapy Department, CSEU La Salle, UAM, Madrid, Spain
Introduction: Idiopathic toe walking (ITW) is a common paediatric gait disorder characterised by excessive plantar flexion during the gait cycle [1]. Conservative treatment is part of the global management and must be considered as the first step of the treatment algorithm [2]. The aim of this study is to evaluate the clinical impact of a home-based exercise program associated with the use of a night splint (AFO) for managing gait problems in children with ITW. Research question: Is the conservative treatment an option to consider for clinical management of gait disorders in children with ITW? Methods: A kinematic comparative study was developed in order to check long-term effects of the treatment on gait parameters. Follow-ups were conducted at 6, 12, and 18 months. 29 children with ITW and 15 healthy children. The proposed treatment was a home-based exercise program in combination with the use of a night splint for 12 months. Results: Several kinematic values improved and a normalization of gait kinematics was observed at the 18-month follow-up. We found statistically significant differences for gait kinematics (A1, A3, A5 and GDI) (Table 1).
* Corresponding author. E-mail address: [email protected] (S.L. Lara). http://dx.doi.org/10.1016/j.gaitpost.2016.07.246 0966-6362/
Table 1 Ankle kinematic values. Baseline and follow-up of the outcome measures. Outcome Base line measures
6 months F-UP
12 months F-UP
18 months F-UP
P value
A1 A3 A5 GDI
( )10.4 8.7 4.7 8.8 ( )4.3 6.1 91.4 4.2
( )5.5 4.1 10.4 3.8 ( )1.1 4.1 94.3 4.7
( )2.9 4.1 12.7 3.4 0.4 3.9 97.6 4.1
<0.0001 <0.0001 <0.0001 <0.0001
( )15.5 10.2 0.8 13.3 ( )6.4 9.5 88 3.3
Discussion: 3D gait analysis is an assessment tool for gait disorders and for long-term follow-up of children with ITW. Our home-based exercise associated with a night splint showed good results for gait disorders treatment in children with ITW. Similar results were reported using casting or botulinum toxin injections [3]. According to our results surgical management must be taken in consideration just for conservative treatment failures. References [1] Engelbert R. BMC Musculoskelet. Disord. 2011;21(12):61. [2] Clark E. Pediatr. Phys. Ther. 2010;22(4):417–26. [3] Engstro¨m P. J. Bone Joint Surg. Am. 2013;95:400–7.