title: A comparison of orthoses in the treatment of idiopathic toe walking: A randomized controlled trial.
abstract: BACKGROUND
  Orthotic treatment of idiopathic toe walking is complicated by the lack of a known etiology. This study compared control of toe walking using an articulated ankle-foot orthosis versus a rigid carbon fiber footplate attached to a foot orthosis.
  
  
  OBJECTIVE
  Ascertain differences between two orthoses in the control of idiopathic toe walking.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  A total of 18 children with idiopathic toe walking were randomized to either the ankle-foot orthosis or foot orthosis treatment group in a Parallel Randomized Controlled Trial with no blinding. Prior to and after 6 weeks of treatment, participants completed three-dimensional gait assessment and the L-test of Functional Mobility. Parents completed a satisfaction survey and a subset of the Orthotic and Prosthetic User Survey after treatment.
  
  
  RESULTS
  Nine participants were analyzed in each group. Both groups showed significant improvement in kinematics versus baseline with orthoses; however, when the orthoses were removed, the ankle-foot orthosis group did not immediately sustain this improvement, while the foot orthosis group did. Parents preferred the foot orthosis for donning and appearance.
  
  
  CONCLUSIONS
  The ankle-foot orthosis controls idiopathic toe walking, but subjects may revert to earlier patterns following treatment. The foot orthosis does not control idiopathic toe walking as well but is less restrictive and more accepted by children and their parents, with similar out-of-brace effects.
  
  
  CONCLUSIONS
  This study suggests that sequential orthotic treatment for children with idiopathic toe walking (ITW) may be beneficial. Initial treatment could include a less restrictive orthosis like a foot orthosis (FO); if this is unsuccessful within a set time frame, then the patient may require a more restrictive form of treatment such as an ankle-foot orthosis (AFO).
authors: Ortho Pro Associates, Inc., Miami, FL, USA kinsey@orthoproassociates.com.
authors: Kinsey
authors: K
authors: Herrin
authors: Biomechanics Laboratory, Georgia State University, Atlanta, GA, USA.
authors: Mark
authors: M
authors: Geil
mesh_terms: D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D061826:Foot Orthoses; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology; D014034:Toes; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology
keywords: Biomechanics of prosthetic/orthotic devices; biomechanics; gait; gait analysis; idiopathic toe walking; lower limb orthotics; orthotics; toe walking