Efficacy of serial casting protocols in idiopathic toe-walking.
Tyler Shirel, Tonye Sylvanus, Kelly Cho and 2 others
PMID 38669491WHAT IT FOUND
Ankle motion improved with serial casting in children with idiopathic toe-walking.
Weekly cast changes showed faster motion improvement in the first two weeks and by final cast removal than changes every two weeks, but toe-walking recurrence was similar.
Key findings
01Weekly cast changes had greater ankle range of motion improvement from baseline to two weeks and from baseline to final measurement.
02Ankle range of motion increased across time in both the weekly and two-week casting groups.
03Recurrence of toe-walking was 33% in the weekly casting group and 29% in the two-week casting group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was retrospective, and missing chart documentation, especially ankle range of motion measurements, limited the data. Casting intervals and stopping decisions were not standardized; each treating pediatric physiatrist chose them, so the groups were not randomly assigned. The weekly group began with more limited ankle motion (-5.4° vs 1.4°), and clinicians may have chosen weekly changes because those children had tighter ankles. The weekly group was small, and both groups had few participants at the two-to-four-week follow-up. This reduced the study's power. Assessments were done by several providers, which increased the risk of measurement error. Eight participants in each group did not return for follow-up, and the reason was unclear; it could have reflected satisfaction or dissatisfaction with casting.
The easy way to misread this
Do not conclude that weekly casting is the better treatment overall. The study did not randomly assign children to intervals, the weekly group started with more limited ankle motion, and recurrence of toe-walking after casting was similar between groups.