Results Mean age preoperatively was 11.4 yr (range 8-14) and at follow-up 17.3 yr (range 13-21). Patellar avulsions and fractures healed (one with fibrous union). Knee pain diminished (p
O-55 COMPREHENSIVE GAIT ANALYSIS OUTCOMES OF SURGICALLY TREATED IDIOPATHIC TOE-WALKERS Baird, Glen, MD, McMulkin, Mark, PhD, Caskey, Paul, MD, Ferguson, Ron, MD Motion Analysis Lab, Shriners Hospitals for Children, Spokane, Washington, USA Summary/conclusions Idiopathic toe-walkers that <strong>de</strong>velop a gastrocnemius/soleus contracture present with gait <strong>de</strong>viations in addition to equinus that inclu<strong>de</strong>d mildly increased pelvic tilt, <strong>de</strong>creased peak knee flexion in swing, and increased external foot progression. Idiopathic toe-walkers had an overall improvement following appropriate surgery, Tendo-Achilles Lengthening (TAL) for those patients with more severe contracture and gastrocnemius lengthening (Vulpius procedure) for those patients with primarily gastrocnemius tightness. Mild remaining <strong>de</strong>viations inclu<strong>de</strong>d reduced peak dorsiflexion in stance, mildly increased pelvic tilt, and external foot progression. Introduction Treatment of idiopathic toe-walking can inclu<strong>de</strong> surgical lengthening of the gastrocnemius/soleus complex when conservative options have been unsuccessful. Previous outcomes reports of surgery for toe-walking have largely been limited to assessing the sagittal plane motion of dorsiflexion/plantarflexion with minimal quantitative pre-and post-operative analysis [1-3]. The purpose of this study was to evaluate the gait characteristics of idiopathic toe-walkers and to comprehensively assess the outcome of idiopathic toe-walkers treated surgically. Statement of clinical significance It is important to un<strong>de</strong>rstand the full extent of <strong>de</strong>viations present in idiopathic toe-walkers, so that we may be able to more accurately predict how they will walk following surgical intervention. Methods Fourteen children that un<strong>de</strong>rwent surgical lengthening for idiopathic toe-walking were inclu<strong>de</strong>d in this retrospective study. 3-D computerized gait analysis was performed on all subjects pre-operatively and at a mean of 13 months (range 10-17) post-operatively. Seven subjects had Vulpius procedures bilaterally (primarily gastrocnemius lengthening), and 7 had TALs (6 percutaneous and 1 open z-lengthening of the Achilles tendon). The mean age at surgery for the Vulpius group was 9.3 years compared to 8.5 years for the TAL group. A TAL was performed when there was limited dorsiflexion with the knee exten<strong>de</strong>d (mean -9.1º) and flexed (mean -0.1º). A Vulpius procedure was completed when there was limited dorsiflexion with the knee exten<strong>de</strong>d (mean 1.5º) and a<strong>de</strong>quate range with the knee flexed (mean 8.1º). Kinematic and kinetic data for the group as a whole were used to <strong>de</strong>termine pre-operative <strong>de</strong>viations from normal, changes from pre-to post-operative, and residual <strong>de</strong>viations postoperative from normal. The idiopathic toe-walkers were also grouped by surgical intervention (TAL vs. Vulpius) for comparison. Results Compared to normative controls, idiopathic toe-walkers as a group had significantly greater anterior pelvic tilt, <strong>de</strong>creased peak knee flexion in swing, and greater external foot progression, in addition to the expected increased ankle plantarflexion pre-operatively (Table 1). When grouped by surgical type, the TAL group walked pre-operatively with significantly less peak stance phase dorsiflexion (mean -7.8º) than the Vulpius group (mean 6.1º). Kinetically, the subjects had lower peak ankle power generation in late stance prior to surgery (regardless of - 182 -
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