Efficacy of serial casting protocols in idiopathic toe-walking

PURPOSE: Idiopathic toe-walking (ITW) is a diagnosis of exclusion. A relationship between ITW and decreased range of motion (ROM) is postulated. Treatments focus on increasing ankle dorsiflexion including serial casting. There is no consensus for duration of serial casting. This study aimed to determine ROM changes with cast change intervals of one vs. two weeks, and the rate of ITW recurrence. METHODS: This was a retrospective study of 86 patients, ages 0–9 years with ITW undergoing weekly casting (N = 29) and two-week casting (N = 57) at a children’s hospital from 2014–2020. ROM at baseline, two weeks, four weeks, and final cast removal were collected. Statistical analyses included chi-squared tests, two-sample t-tests, and linear mixed regression. Outcome distributions were assessed for normality. P-values <  0.05 were considered statistically significant. RESULTS: After adjusting for baseline ROM, the mean change in ROM from baseline to two weeks was 10.6∘ vs 7.5∘ in the one-week vs. two-week casting interval, respectively (p <  0.001). The baseline to final measurement was 13.4∘ vs 9.8∘ in the one-week vs. two-week casting interval, respectively (p <  0.001). The rate of recurrence of ITW was similar between the two groups. CONCLUSION: This study suggests greater improvement in ROM in the one-week vs. two-week casting interval group.