Surgical treatment for idiopathic toe walkers gives good biomechanical and patient satisfaction outcomes

Purpose To assess the impact of bilateral surgical calf lengthening in patients with idiopathic toe walking (ITW) and calf contracture, including those with an autism diagnosis. Methods Clinical assessment included passive range of motion and 3D gait analysis to capture kinematic and kinetic data. Temporal spatial parameters were measured. Gait Profile Scores (GPS) were calculated to evaluate gait normalcy, and Gait Variable Scores (GVS) identified the components of any change. Ankle push-off power was analysed. Patient satisfaction was assessed via questionnaires. Statistical analysis included paired t-tests and Wilcoxon signed-rank tests. Results Thirty-eight patients were included; 34 had complete kinematic and 30 had complete kinetic data. Mean age at surgery was 10.3 yrs and mean follow-up was 1.3±0.4 yrs. Ankle dorsiflexion showed a significant improvement. Walking speed increased due to increased step length, while cadence was reduced. GPS improved from 11.4º from the norm preoperatively to 6.2º postoperatively (p<0.001). GVS improved for ankle dorsiflexion (p<0.001) and pelvic tilt (p<0.005). Peak ankle power generation and work done during late stance significantly increased. Pain decreased postoperatively and patient satisfaction was high. There were no adverse biomechanical outcomes such as recurrence or overcorrection. Conclusion Calf lengthening surgery for ITW has demonstrated improved clinical, kinematic and kinetic outcomes in gait analysis at one-year. High levels of satisfaction, with notable improvements in mobility and pain management postoperatively, were reported. However, longer-term follow-up to evaluate sustained benefits is needed.