1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

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 develop a gastrocnemius/soleus contracture present with gait
deviations in addition to equinus that included mildly increased pelvic tilt, decreased 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
deviations included reduced peak dorsiflexion in stance, mildly increased pelvic tilt, and
external foot progression.
Introduction
Treatment of idiopathic toe-walking can include 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 understand the full extent of deviations 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 underwent surgical lengthening for idiopathic toe-walking were
included 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 extended (mean -9.1º) and
flexed (mean -0.1º). A Vulpius procedure was completed when there was limited dorsiflexion
with the knee extended (mean 1.5º) and adequate range with the knee flexed (mean 8.1º).
Kinematic and kinetic data for the group as a whole were used to determine pre-operative
deviations from normal, changes from pre-to post-operative, and residual deviations 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, decreased 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
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