BACKGROUND: Numerous recommendations have been made for treating idiopathic toe-walking (ITW), but the treatment results have been questioned. The purpose of this study was to investigate whether botulinum toxin A (BTX) improves the walking pattern in ITW as examined with 3-D gait analysis. PARTICIPANTS AND METHODS: A consecutive series of 15 children (aged 5-13 years) were enrolled in the study. The children underwent a 3-D gait analysis prior to treatment with a total of 6 units/kg bodyweight Botox(®) in the calf muscles and an exercise program. The gait analysis was repeated 3 weeks and 3, 6, and 12 months after treatment. A classification of toe-walking severity was made before treatment and after 12 months. The parents rated the perceived amount of toe-walking prior to treatment and 6 and 12 months after treatment. RESULTS: Eleven children completed the 12-month follow-up. The gait analysis results displayed a significant improvement, indicating decreased plantarflexion angle at initial contact and during swing phase and increased dorsiflexion angle during midstance at all post-treatment testing instances. According to the parents' perception of toe-walking, 3/11 children followed for 12 months had ceased toe-walking completely, 4/11 decreased toe-walking, and 4/11 continued toe-walking. After 6-12 months, the toe-walking severity classification improved in 9 of the 14 children for whom data could be assessed. CONCLUSIONS: A single injection of BTX in combination with an exercise program can improve the walking pattern in children with ITW seen at gait analysis, but the obvious goal of ceasing toe-walking is only occasionally reached.
BACKGROUND: Numerous recommendations have been made for treating idiopathic toe-walking (ITW), but the treatment results have been questioned. The purpose of this study was to investigate whether botulinum toxin A (BTX) improves the walking pattern in ITW as examined with 3-D gait analysis. PARTICIPANTS AND METHODS: A consecutive series of 15 children (aged 5-13 years) were enrolled in the study. The children underwent a 3-D gait analysis prior to treatment with a total of 6 units/kg bodyweight Botox(®) in the calf muscles and an exercise program. The gait analysis was repeated 3 weeks and 3, 6, and 12 months after treatment. A classification of toe-walking severity was made before treatment and after 12 months. The parents rated the perceived amount of toe-walking prior to treatment and 6 and 12 months after treatment. RESULTS: Eleven children completed the 12-month follow-up. The gait analysis results displayed a significant improvement, indicating decreased plantarflexion angle at initial contact and during swing phase and increased dorsiflexion angle during midstance at all post-treatment testing instances. According to the parents' perception of toe-walking, 3/11 children followed for 12 months had ceased toe-walking completely, 4/11 decreased toe-walking, and 4/11 continued toe-walking. After 6-12 months, the toe-walking severity classification improved in 9 of the 14 children for whom data could be assessed. CONCLUSIONS: A single injection of BTX in combination with an exercise program can improve the walking pattern in children with ITW seen at gait analysis, but the obvious goal of ceasing toe-walking is only occasionally reached.
Authors: N Susan Stott; Sharon E Walt; Glenis A Lobb; Nicola Reynolds; Richard O Nicol Journal: J Pediatr Orthop Date: 2004 Jan-Feb Impact factor: 2.324
Authors: H K Graham; K R Aoki; I Autti-Rämö; R N Boyd; M R Delgado; D J Gaebler-Spira; M E Gormley; B M Guyer; F Heinen; A F Holton; D Matthews; G Molenaers; F Motta; P J García Ruiz; J Wissel Journal: Gait Posture Date: 2000-02 Impact factor: 2.840
Authors: Yoram Hemo; Samuel J Macdessi; Rosemary A Pierce; Michael D Aiona; Michael D Sussman Journal: J Pediatr Orthop Date: 2006 May-Jun Impact factor: 2.324
Authors: Antoni J Caserta; Verity Pacey; Michael Fahey; Kelly Gray; Raoul Hh Engelbert; Cylie M Williams Journal: Cochrane Database Syst Rev Date: 2019-10-06