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Children who continue to walk on their tiptoes after developing a heel-toe gait normally are diagnosed with idiopathic toe walking (ITW). The study's aim was to investigate the effects of serial casting and physical therapy on joint range of motion (ROM), toe walking severity, functional health and health-related quality of life, walking balance, and satisfaction from treatment in ITW, in comparison with the control group.
Children with ITW aged 3-10 years are randomized into three groups: the serial casting group (n=10), the physical therapy group (n=10), and the wait-list control group (n=10). Patients with ankle contracture and previous interventions are excluded. The serial casting group is planned to receive intermittent serial casting once every three days for three weeks. The physical therapy group is planned to undergo three sessions per week for three weeks, consisting of stretching exercises, strengthening exercises, balance training, proprioception exercises, and walking on heels. The patients were assessed by blinded investigators at before treatment (BT), post-treatment (PT: 3th week), 1st month (1MPT), 3rd months (3MPT), and 6th months post-treatment (6MPT). To ensure ethical considerations, only control group was followed-up until the 1MPT.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Serial Casting | Active Comparator | The serial casting group received intermittent serial casting once every three days for three weeks. |
|
| Exercise | Active Comparator | The physical therapy group underwent three sessions per week for three weeks, consisting of stretching exercises, strengthening exercises, balance training, proprioception exercises, and walking on heels. |
|
| Control Group | No Intervention | This group consists of the patients on the waitlist. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Serial Casting | Other | A short leg cast is applied to the serial casting group by an orthopedic specialist once every three days for three weeks. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Range of Motion (ROM) | Ankle dorsiflexion ROM with extended knee | Day 0 |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with extended knee | 3rd week |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with extended knee | 7th week |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with extended knee | 15th week |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with extended knee | 27th week |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with flexed knee | Day 0 |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with flexed knee | 3rd week |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with flexed knee | 7th week |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with flexed knee |
| Measure | Description | Time Frame |
|---|---|---|
| Pediatric Outcomes Data Collection Instrument (PODCI) | PODCI evaluates functional health status through an 86 item questionnaire. Scoring varies greatly due to the multiple weighted scores of some items, scores range from 0-3 for some items and 0-6 for others. The overall score comes from 4 functional assessment scores, a global function score, and a happiness score. These scores range from 0-100 with lower scores representing higher levels of disability. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Esra Giray | Contact | +905558134394 | girayesra@hotmail.com | |
| Özge İlleez | Contact | +905326255684 | ozgeilleez@hotmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Esra Giray | Fatih Sultan Mehmet training and Research Hospital, Istanbul-Turkey | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fatih Sultan Mehmet Trainig and Research Hospital | Istanbul | 34752 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28092971 | Background | Pomarino D, Ramirez Llamas J, Martin S, Pomarino A. Literature Review of Idiopathic Toe Walking: Etiology, Prevalence, Classification, and Treatment. Foot Ankle Spec. 2017 Aug;10(4):337-342. doi: 10.1177/1938640016687370. Epub 2017 Jan 16. | |
| 21418634 | Background | Engelbert R, Gorter JW, Uiterwaal C, van de Putte E, Helders P. Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness? BMC Musculoskelet Disord. 2011 Mar 21;12:61. doi: 10.1186/1471-2474-12-61. |
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D015444 | Exercise |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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Randomized, single blinded, controlled study
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| Exercise | Other | Stretching exercises, strengthening exercises, balance exercises, proprioception exercises, and heel walking exercises are applied to the physical therapy group for 3 weeks with a physiotherapist for 3 sessions a week. |
|
| 15th week |
| Range of Motion (ROM) | Ankle dorsiflexion ROM with flexed knee | 27th week |
| Toe Walking Severity Scale | The family is asked how long the child tiptoe walks during the day. The evaluation is as follows. Stage 1: Toe walking 76-100% of the time Stage 2: Toe walking 51-75% of the time Stage 3: Toe walking 26-50% of the time Stage 4: Toe walking 10-25% of the time Stage 5: Sole pressing but early heel lift (occasional toe gait <10%) Stage 6: Normal heel strike | Day 0 |
| Toe Walking Severity Scale | The family is asked how long the child tiptoe walks during the day. The evaluation is as follows. Stage 1: Toe walking 76-100% of the time Stage 2: Toe walking 51-75% of the time Stage 3: Toe walking 26-50% of the time Stage 4: Toe walking 10-25% of the time Stage 5: Sole pressing but early heel lift (occasional toe gait <10%) Stage 6: Normal heel strike | 3rd week |
| Toe Walking Severity Scale | The family is asked how long the child tiptoe walks during the day. The evaluation is as follows. Stage 1: Toe walking 76-100% of the time Stage 2: Toe walking 51-75% of the time Stage 3: Toe walking 26-50% of the time Stage 4: Toe walking 10-25% of the time Stage 5: Sole pressing but early heel lift (occasional toe gait <10%) Stage 6: Normal heel strike | 7th week |
| Toe Walking Severity Scale | The family is asked how long the child tiptoe walks during the day. The evaluation is as follows. Stage 1: Toe walking 76-100% of the time Stage 2: Toe walking 51-75% of the time Stage 3: Toe walking 26-50% of the time Stage 4: Toe walking 10-25% of the time Stage 5: Sole pressing but early heel lift (occasional toe gait <10%) Stage 6: Normal heel strike | 15th week |
| Toe Walking Severity Scale | The family is asked how long the child tiptoe walks during the day. The evaluation is as follows. Stage 1: Toe walking 76-100% of the time Stage 2: Toe walking 51-75% of the time Stage 3: Toe walking 26-50% of the time Stage 4: Toe walking 10-25% of the time Stage 5: Sole pressing but early heel lift (occasional toe gait <10%) Stage 6: Normal heel strike | 27th week |
| Day 0 |
| Pediatric Outcomes Data Collection Instrument (PODCI) | PODCI evaluates functional health status through an 86 item questionnaire. Scoring varies greatly due to the multiple weighted scores of some items, scores range from 0-3 for some items and 0-6 for others. The overall score comes from 4 functional assessment scores, a global function score, and a happiness score. These scores range from 0-100 with lower scores representing higher levels of disability. | 3rd week |
| Pediatric Outcomes Data Collection Instrument (PODCI) | PODCI evaluates functional health status through an 86 item questionnaire. Scoring varies greatly due to the multiple weighted scores of some items, scores range from 0-3 for some items and 0-6 for others. The overall score comes from 4 functional assessment scores, a global function score, and a happiness score. These scores range from 0-100 with lower scores representing higher levels of disability. | 7th week |
| Pediatric Outcomes Data Collection Instrument (PODCI) | PODCI evaluates functional health status through an 86 item questionnaire. Scoring varies greatly due to the multiple weighted scores of some items, scores range from 0-3 for some items and 0-6 for others. The overall score comes from 4 functional assessment scores, a global function score, and a happiness score. These scores range from 0-100 with lower scores representing higher levels of disability. | 15th week |
| Pediatric Outcomes Data Collection Instrument (PODCI) | PODCI evaluates functional health status through an 86 item questionnaire. Scoring varies greatly due to the multiple weighted scores of some items, scores range from 0-3 for some items and 0-6 for others. The overall score comes from 4 functional assessment scores, a global function score, and a happiness score. These scores range from 0-100 with lower scores representing higher levels of disability. | 27th week |
| Tandem Walk Test | The participants are asked to walk in a straight line with one foot just in front of the other (heel to toe), arms at their sides. | Day 0 |
| Tandem Walk Test | The participants are asked to walk in a straight line with one foot just in front of the other (heel to toe), arms at their sides. | 3rd week |
| Tandem Walk Test | The participants are asked to walk in a straight line with one foot just in front of the other (heel to toe), arms at their sides. | 7th week |
| Tandem Walk Test | The participants are asked to walk in a straight line with one foot just in front of the other (heel to toe), arms at their sides. | 15th week |
| Tandem Walk Test | The participants are asked to walk in a straight line with one foot just in front of the other (heel to toe), arms at their sides. | 27th week |
| Visual Analog Scale | All participants are asked about satisfaction with treatment through a smiley face visual analog scale 'smiley face' visual analogue scale (0-10, 0 for full satisfaction) | 3rd week |
| Visual Analog Scale | All participants are asked about satisfaction with treatment through a smiley face visual analog scale 'smiley face' visual analogue scale (0-10, 0 for full satisfaction) | 7th week |
| Visual Analog Scale | All participants are asked about satisfaction with treatment through a smiley face visual analog scale 'smiley face' visual analogue scale (0-10, 0 for full satisfaction) | 15th week |
| Visual Analog Scale | All participants are asked about satisfaction with treatment through a smiley face visual analog scale 'smiley face' visual analogue scale (0-10, 0 for full satisfaction) | 27th week |
| 25628380 | Background | Herrin K, Geil M. A comparison of orthoses in the treatment of idiopathic toe walking: A randomized controlled trial. Prosthet Orthot Int. 2016 Apr;40(2):262-9. doi: 10.1177/0309364614564023. Epub 2015 Jan 27. |
| 27370652 | Background | Pomarino D, Ramirez Llamas J, Pomarino A. Idiopathic Toe Walking: Family Predisposition and Gender Distribution. Foot Ankle Spec. 2016 Oct;9(5):417-22. doi: 10.1177/1938640016656780. Epub 2016 Jul 1. |
| 27089542 | Background | Satila H, Beilmann A, Olsen P, Helander H, Eskelinen M, Huhtala H. Does Botulinum Toxin A Treatment Enhance the Walking Pattern in Idiopathic Toe-Walking? Neuropediatrics. 2016 Jun;47(3):162-8. doi: 10.1055/s-0036-1582138. Epub 2016 Apr 18. |
| 23467862 | Background | Engstrom P, Bartonek A, Tedroff K, Orefelt C, Haglund-Akerlind Y, Gutierrez-Farewik EM. Botulinum toxin A does not improve the results of cast treatment for idiopathic toe-walking: a randomized controlled trial. J Bone Joint Surg Am. 2013 Mar 6;95(5):400-7. doi: 10.2106/JBJS.L.00889. |
| 20692159 | Background | Williams CM, Tinley P, Curtin M. The Toe Walking Tool: a novel method for assessing idiopathic toe walking children. Gait Posture. 2010 Oct;32(4):508-11. doi: 10.1016/j.gaitpost.2010.07.011. Epub 2010 Aug 7. |
| 40167594 | Derived | Giray E, Akpinar P, Illeez OG, Kahraman HC, Kocibar M, Kutsal A, Hacifazlioglu NE, Uyur E, Unlu Ozkan F, Aktas I, Yilmaz B, Karadag-Saygi E. A comparative randomized-controlled trial of serial casting and exercises on ankle range of motion, toe walking severity, walking balance, and functional health-related quality of life in children with idiopathic toe walking. J Pediatr Orthop B. 2025 Sep 1;34(5):465-476. doi: 10.1097/BPB.0000000000001250. Epub 2025 Jul 29. |