Treatment for idiopathic toe walking: a systematic review of the literature.

OBJECTIVE To assess the effectiveness of currently available treatment options for idiopathic toe walking on the 3 main levels of the World Health Organization International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY). DESIGN A systematic search from 1966 to December 2013 in MEDLINE, Current Contents, CINAHL and the Cochrane Library of full-length articles addressing clinical efficacy of treatment in children aged 2-18 years. METHODS Studies were evaluated using both the Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence and the Methodological Index for Non-Randomised Studies (MINORS). Outcomes were analysed in accordance with the ICF-CY. RESULTS One randomized controlled trial and 18 observational studies were identified. The randomized controlled trial was scored OCEBM level 1, whereas the other studies were scored level 4. The MINORS scores ranged from 2 to 18. CONCLUSION There is preliminary evidence for beneficial effects of serial casting and surgery on passive ankle dorsiflexion as well as on walking kinetics and kinematics, although normalization does not seem to occur. Botulinum toxin type A does not improve the results of casting. Only after surgery are sustainable effects lasting > 1 year reported. Effectiveness on functional activities and social participation has yet to be demonstrated.