Outcomes Following Surgical Correction of Toe Walking

Objective: The purpose of this study is to evaluate the outcomes and complications in children who underwent Tendo-Achilles lengthening (TAL) surgery for idiopathic toe walking (ITW).

Methods: A retrospective review of medical records was performed of one pediatric orthopaedic surgeon’s practice from 2009-2015. Demographic information, prior treatments, consultations, and imaging studies were recorded. Post-operative follow-up, range of motion, return to activity, and complications were also tabulated.

Results: Thirty-seven total patients were studied (24 males and 13 females). The average age was 8.1 years (range: 2.5 - 16.25 years). Five children (14%) had a positive family history of toe walking. Five patients (14 %) had autism. Prior to surgery, 5 (14%) had serial casting and 1 (3%) had Botox injections. Preoperatively, 24 patients (65%) had a neurology consult. MRI was performed in 21 (57%) patients to rule out neurological conditions (all of which were negative). All 37 patients had bilateral TAL’s. The average follow-up post-surgery was 14 months. The average dorsiflexion increase after surgery was 23° and the average return to activity as tolerated after surgery was 6 months. Thirty-six of 37 (97%) patients were corrected by TAL. No infections, wound dehiscence, over-lengthening’s, or nerve injury occurred.

Conclusion: Delay in referral for potential surgical correction of ITW is common due to an unfounded fear of surgery. In the current study, children younger than 10 years at surgical correction had greater increase in ankle dorsiflexion and quicker time returning to normal activity. TAL for toe walking is safe and is 97% effective.

Keywords: Idiopathic toe walking, ITW, Tendo-Achilles lengthening.