title: Non-invasive serial casting to treat idiopathic toe walking in an 18-month old child.
abstract: BACKGROUND
  Idiopathic toe walking is characterized by persistent toe walking in the absence of clinically diagnosed neuromuscular disease. Treatment options in children diagnosed with idiopathic toe walking include: observation, physical therapy, serial casting, or Achilles tendon (heel cord) lengthening surgery.
  
  
  OBJECTIVE
  In this case report, we present a non-invasive serial casting protocol to treat severe and persistent toe walking in an 18-month old child, diagnosed as an idiopathic toe walker following neurological examination.
  
  
  METHODS
  A series of below knee casts was used to provide a consistent stretch to the plantar flexor muscles. Upon removal of each set of casts, passive range of motion at the ankles was measured with a goniometer.
  
  
  RESULTS
  Four sets of casts, each lasting approximately one week, increased passive ankle dorsiflexion to 10° of neutral and established a heel-toe walking gait. Improvements in ankle range of motion and gait were maintained upon repeated examinations at 3, 7, and 12 months post-casting.
  
  
  CONCLUSIONS
  These results demonstrate that non-invasive procedures, such as serial casting, can be successful in very young children diagnosed as idiopathic toe walkers. Early identification and intervention for this diagnosis may eliminate the need for invasive surgeries and associated risks in this population.
authors.affiliation: Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV, USA Center for Cardiovascular and Respiratory Sciences, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Emidio E
authors.initials: EE
authors.lastname: Pistilli
authors.affiliation: Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Rice
authors.affiliation: Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Paola
authors.initials: P
authors.lastname: Pergami
authors.affiliation: Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Mandich
mesh_terms: D000843:Ankle Joint / Q000502:physiology*; D002370:Casts, Surgical; D005260:Female; D005684:Gait / Q000502:physiology; D020235:Gait Apraxia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D016059:Range of Motion, Articular / Q000502:physiology*; D012021:Reflex, Abnormal / Q000502:physiology; D014034:Toes; D016138:Walking / Q000502:physiology
keywords: Equinus; contracture; toe walking