BACKGROUND: Idiopathic toe walking is a diagnosis of exclusion characterized by 
a persistent toe-toe gait pattern after three years of age. Treatment for toe 
walking includes physical therapy, orthotics, casting, Botulinum Toxin A 
injection into gastrocnemius/soleus muscles, and/or surgery; yet, little 
evidence exists regarding long-term treatment effects.
RESEARCH QUESTION: The objective of this study was to explore the differences in 
longer-term gait outcomes and severity of idiopathic toe walking between 
children treated actively with casting or inactively following recommendations 
for stretching.
METHODS: Forty-three adolescents and young adults (14.3-28.8 years; 21 females, 
22 males) who had participated in an idiopathic toe walking classification study 
as children, returned for repeat physical examination and three-dimensional 
computerized gait analysis (13.4 years follow-up, range 9.4-17.8 years); 23 
participants had received active treatment with casting and ankle foot 
orthotics ± Botulinum Toxin A injection as children and 20 participants had 
received inactive treatment with recommended stretching exercises. Gait analysis 
data were compared retrospectively from baseline to follow-up using analysis of 
variance; toe walking severity was compared using a Wilcoxin Signed-Rank Sums 
test.
RESULTS: Ankle angle at initial contact, peak dorsiflexion in stance, and toe 
walking severity improved significantly in the active treatment group only at 
follow-up. Significant improvement in peak ankle power and timing of ankle 
kinematics and kinetics in the gait cycle were found in both groups; however, 
greater changes occurred in the active treatment group. Both groups showed 
significantly improved internal plantar flexor moments, whereas knee extension 
increased in stance and passive ankle dorsiflexion decreased in both groups at 
follow-up (p = 0.001). Intermittent toe walking was reported in 49% (21/43) of 
participants at follow-up.
SIGNIFICANCE: The results of this study suggest that improvement in ankle 
kinematic timing and ankle kinetic gait analysis variables is sustainable, 
independent of conservative treatment for idiopathic toe walking in childhood.