Toe-walking in children younger than six years with cerebral palsy

Abstract

Our aim in this retrospective study was to analyse the value of serial corrective casts in the management of toe-walking in children aged less than six years with cerebral palsy. A total of 20 children (10 hemiplegic and 10 diplegic) had elongation of the triceps surae by serial casting at a mean age of four years and one month. The mean passive dorsiflexion of the foot with the knee in extension was 3 degrees (-10 to +5) and 12 degrees (0 to +15) with the knee in flexion. After removal of the cast passive dorsiflexion was 20 degrees (+10 to +30) with the knee in extension, and 28 (+10 to +35) with the knee in flexion. At a mean follow-up of 3.08 years (2.08 to 4.92), passive dorsiflexion was 9 degrees (-10 to +20) with the knee in extension and 18 degrees (0 to +30) with the knee in flexion. Serial corrective casts are useful for the treatment of equinus in young children as the procedure is simple and the results are at least equal to those of other non-operative techniques. It is a safe alternative to surgical procedures especially in young children. If the equinus recurs operation can be undertaken on a tendon which is not scarred.

Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy

“…tone, posture, range of motion), and provided therapy to remediate the impairments (motor, cognitive, or sensory) and practice specific movements and tasks. Therapists chose their treatment strategies from contemporary interventions discussed in the literature such as maintaining range of motion and joint alignment through stretching, casting, and splinting, 23–26 strength training, 27–30 sensorimotor training and stimulation, 31 bilateral isokinematic training, 32 weight-bearing through the hands, 33 and facilitation of normal movement patterns and postural control through physical handling and practice of functional activities. 34,35 Thus, the child-focused approach used a combination of therapeutic strategies focused on remediation of impairments and building children's skills and abilities through practice of functional activities.…”

A systematic review of the effects of casting on equinus in children with cerebral palsy: an evidence report of the AACPDM

“…Case series df: one cast/w for 3w walk independently without (mean 4y 1mo) (2000) 35 followed by below knee night aids; toe-walking; fixed triceps splint and physiotherapy surae contracture no more than with repeated passive 10˚ of fixed equinus with stretching of tendon knees extended and no static ankle varus or valgus deformity; no previous surgery a This study appears three times in the table, representing the three two-way comparisons between casting, BTX-A, and combined treatment. b Separate results given for participants with CP.…”

“…Case series df: one cast/w for 3w walk independently without (mean 4y 1mo) (2000) 35 followed by below knee night aids; toe-walking; fixed triceps splint and physiotherapy surae contracture no more than with repeated passive 10˚ of fixed equinus with stretching of tendon knees extended and no static ankle varus or valgus deformity; no previous surgery 36 for 3-6w ITW (mean 7y 6mo) Most investigators of the effects of casting and BTX-A have looked for changes in calf spasticity, ankle ROM, and gait parameters. These outcomes are represented by the components of body function and structure in the ICF.…”

Efficacy of botulinum toxin A, serial casting, and combined treatment for spastic equinus: a retrospective analysis

“…When children with CP were compared with those in an unaffected control group, the children with CP produced maximum force at a more plantar flexed angle. Cottalorda et al (2000) retrospectively studied casting in children. The casting was followed by a night splinting program.…”