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      Effect of a nonsurgical treatment program on the gait pattern of idiopathic toe walking: a case report

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          Abstract

          Background

          Recent studies have reported many possibilities for the treatment of idiopathic toe walking (ITW); however, none of them have been sufficiently documented. The purpose of this case study was to document the evolution of the gait pattern of a child with severe ITW using the Gillette Gait Index before and after the third and sixth weeks, a nonsurgical treatment program and then every 3 months to 1 year from the start of the treatment. This is significant because the case study shows that a nonsurgical treatment program can be an alternative treatment method for children with severe ITW.

          Case description

          The case study involved a 5-year-old boy diagnosed with severe ITW. An orthopedist recommended a surgical treatment, but his parents refused to provide consent.

          Intervention

          The subject participated in a 12-week nonsurgical treatment program that used tone-inhibiting casts (TICs) combined with physiotherapy based on neurodevelopmental treatment principles. The treatment protocol included the following: 1) precast preparation; 2) TICs with treatment; and 3) post-cast treatment to improve the gait pattern.

          Outcomes

          After treatment with TICs, the range of motion of ankle dorsiflexion during stance had increased, resulting in an almost normalized gait. The patient stopped toe walking for at least 1 year.

          Discussion

          This study demonstrates that nonsurgical treatment should be considered first, with surgical options reserved for resistant cases; however, further research is required given the current lack of knowledge about treatment outcomes using TICs and the wide use of this treatment modality in children with ITW.

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          Most cited references 23

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          The development of mature gait.

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            The effectiveness of passive stretching in children with cerebral palsy.

            Passive stretching is widely used for individuals with spasticity in a belief that tightness or contracture of soft tissues can be corrected and lengthened. Evidence for the efficacy of passive stretching on individuals with spasticity is limited. The aim of this review was to evaluate the evidence on the effectiveness of passive stretching in children with spastic cerebral palsy. Seven studies were selected according to the selection criteria and scored against the Physiotherapy Evidence Database scale. Effect size and 95% confidence intervals were calculated for comparison. There was limited evidence that manual stretching can increase range of movements, reduce spasticity, or improve walking efficiency in children with spasticity. It appeared that sustained stretching of longer duration was preferable to improve range of movements and to reduce spasticity of muscles around the targeted joints. Methods of passive stretching were varied. Further research is required given the present lack of knowledge about treatment outcomes and the wide use of this treatment modality.
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              An index for quantifying deviations from normal gait.

              A method is derived to calculate the amount by which a subject's gait deviates from an average normal profile, and to represent this deviation as a single number. The method uses principal component analysis to derive a set of 16 independent variables from 16 selected gait variables. The sum of the square of these 16 independent variables is interpreted as the deviation of the subject's gait from normal. Statistical tests of the method's validity and an initial demonstration of its clinical utility are included. It is found that using this index, increasing clinical involvement corresponds to increasing index score.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2016
                10 February 2016
                : 12
                : 139-146
                Affiliations
                [1 ]Department of Physiotherapy, Medical University of Silesia, Katowice, Kielce, Poland
                [2 ]Department of Medical Rehabilitation, School of Health Sciences, Medical University of Silesia, Katowice, Kielce, Poland
                [3 ]Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
                [4 ]Department of Adapted Physical Activity and Sport, School of Health Sciences, Medical University of Silesia, Katowice, Poland
                Author notes
                Correspondence: Andrzej Szopa, Department of Physiotherapy, School of Health Sciences, Medical University of Silesia, Medyków 12, 40-752 Katowice, Poland, Tel/fax +48 32 208 8712, Email aszopa@ 123456sum.edu.pl
                Article
                tcrm-12-139
                10.2147/TCRM.S95052
                4762432
                26937193
                © 2016 Szopa et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Case Report

                Medicine

                gillette gait index, tone-inhibiting casts, ndt, rom of ankle dorsiflexion

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