Stance Dorsiflexion Research Articles

Answer to HK Graham

Dear Sir Mr. Graham has some concerns about our study. He writes that after 15 years of continuous work with children with cerebral palsy, he thinks that they have found their first good subject with diplegia who might be a good candidate for isolated calf muscle lengthening. This is in contrast to a previous publication by Graham et al. [1]. In this publication, 65 children with diplegia were operated on with isolated calf muscle lengthening (110 surgical procedures), and a high number of children had postoperative calcaneal gait. Unfortunately, the two studies cannot be compared as no kinematic and kinetic data are published in the study by Graham and colleagues. The selection of surgical procedure of calf muscle lengthening was based on clinical examination and has been explained in our article (p. 56). Overcorrection of the ankle was defined as maximum dorsiflexion in stance above mean +2 SD, i.e., 13° + 8° = 21° (p. 57). Only one limb was overcorrected (dorsiflexion = 21.5°). Thus, it is difficult for us to understand why Mr. Graham writes that “some of these subjects are already showing a peak dorsiflexion in stance of about 27°, which is well above the accepted normal range.” When the study was closed, we had a clinical follow-up period of 3 years. By now this period has been extended nearly 2 years, and during this period we have not observed recurrent equinus or calcaneal gait. All our children with cerebral palsy have a postoperative gait analysis 1 and 5 years after the operation. The outcome from the 5-year postoperative gait analysis will be reported. Yours sincerely Bjorn Lofterod Terje Terjesen

Results of treatment when orthopaedic surgeons follow gait‐analysis recommendations in children with CP

The aim of the present study was to assess the outcome of orthopaedic surgery in ambulant children with cerebral palsy, when the orthopaedic surgeons followed the recommendations from preoperative three-dimensional gait analysis. 55 children, mean age 10 y 11 mo, were clinically evaluated by orthopaedic surgeons who proposed a surgical treatment plan. After gait analysis and subsequent surgery, three groups were defined. In group A, there was agreement between clinical proposals, gait-analysis recommendations, and subsequent surgery in 128 specific surgical procedures. In group B, 54 procedures were performed based on gait analysis, although these procedures had not been proposed at the clinical examination. In group C, 55 surgical procedures that had been proposed after clinical evaluation were not performed because of the gait-analysis recommendations. The children underwent follow-up gait analysis 1 to 2 years after the initial analysis. The kinematic results were satisfactory, with improvement in most of the gait parameters in children who had undergone surgery and no significant deterioration in those who were not operated. In group A, there were significant improvements in maximum hip extension in stance, minimum knee flexion in stance, timing of maximum knee flexion in swing and knee range of motion, maximum ankle dorsiflexion in stance, and mean femur rotation in stance. In group B, there were significant improvements in maximum hip extension in stance, minimum knee flexion in stance, and knee range of motion. We conclude that gait analysis was useful in confirming clinical indications for surgery, in defining indications for surgery that had not been clinically proposed, and for excluding or delaying surgery that was clinically proposed.

Effect of Functional Foot Orthoses on First Metatarsophalangeal Joint Dorsiflexion in Stance and Gait

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed.

Comprehensive Outcomes of Surgically Treated Idiopathic Toe Walkers

The treatment of idiopathic toe walking in children can include surgical lengthening of the gastrocnemius/soleus complex after conservative options have been ineffective. Previous outcome reports of surgery for idiopathic toe walkers have largely been limited to assessing the sagittal plane motion of dorsiflexion/plantar flexion with minimal quantitative preoperative and postoperative analysis. The purpose of this study was to comprehensively assess the outcome of idiopathic toe walkers that had been treated surgically. Fourteen children seen in our motion analysis laboratory that underwent gastrocnemius or tendo-Achilles lengthening for idiopathic toe walking were retrospectively reviewed. Preoperatively, this group had significantly greater anterior pelvic tilt than normal, decreased peak knee flexion in swing, greater external foot progression, and the expected increased plantar flexion (P < 0.01). Postoperatively, anterior pelvic tilt decreased by a mean of about 4 degrees (P < 0.01), only for the group that had tendo-Achilles lengthening because the gastrocnemius group was close to normal preoperatively, and peak knee flexion normalized. The foot progression angle of this group did not change from preoperative values and remained significantly more external than normal, although dorsiflexion in stance significantly improved after surgery (indicating the goal of the surgery was achieved). Increased external foot progression in idiopathic toe walkers is apparently due to increased external tibial torsion and/or external hip rotation but was unaffected by gastrocnemius/soleus surgical lengthening. Significant improvement occurred on an overall index of gait variables, indicating surgery can be an effective treatment of idiopathic toe walkers.

Weight-Bearing Passive Dorsiflexion of the Hallux in Standing Is Not Related to Hallux Dorsiflexion During Walking

Case control study. To explore the validity of the assumptions underpinning the Hubscher maneuver of hallux dorsiflexion in relaxed standing, by comparing the relationship between static and dynamic first metatarsophalangeal (MTP) joint motions in groups differentiated by normal and abnormal clinical test findings. Limitation of motion at the first MTP joint during gait may be due to either structural or functional factors. Functional hallux limitus (FHL) has been proposed as a term to describe the situation in which the first MTP joint shows no limitation when non-weight bearing, but shows limited dorsiflexion during gait. One clinical test of first MTP joint limitation during standing (the Hubscher maneuver or Jack's test) has become widely used in physical therapy, orthopedic, and podiatric assessments, supposedly to assess for the presence of hallux limitations during gait. The utility of the test is based on an assumption that restriction during the static maneuver is predictive of functional limitation at this joint during gait. Despite a lack of evidence for the validity of such an assumption, the outcome of the static test is often used to infer risk of overuse injury or as an outcome for functional therapy. This paper examines the validity of the assumptions supporting this widely used static test. First-MTP-joint motion was assessed using an electromagnetic motion tracking system in cases (n = 15) demonstrating clinically limited passive hallux dorsiflexion in relaxed standing, and in 15 controls matched for age and gender and demonstrating a clinically normal Hubscher maneuver. Maximum hallux dorsiflexion was measured with the subject non-weight bearing (seated), during relaxed standing, and during normal walking. Hallux dorsiflexion was similar in cases and controls when motions were measured non-weight bearing (cases mean +/- SD, 55.0 degrees +/- 11.0 degrees; controls mean + SD, 55.0 degrees +/- 10.7 degrees), confirming the absence of structural joint change. In relaxed standing, maximum dorsiflexion was 50% less in cases (mean +/- SD, 19.0 degrees +/- 8.9 degrees) than in the controls (mean +/- SD, 39.4 degrees +/- 6.1 degrees; P < .001), supporting the initial test outcome and confirming the visual test observation of static functional limitation in the case group. During gait, however, cases (mean +/- SD, 36.4 degrees +/- 9.1 degrees), and controls (mean +/- SD, 36.9 degrees +/- 7.9 degrees) demonstrated comparable maximum dorsiflexion (P = .902). There was no significant relationship between static and dynamic first MTP joint motions (r = 0.186, P = .325). The clinical test of limited passive hallux dorsiflexion in stance is a valid test only of hallux dorsiflexion available during relaxed standing. There is no association between maximum dorsiflexion observed during a static weight-bearing examination and that occurring at the same joint during walking.

The Relationship Between Navicular Drop and First Metatarsophalangeal Joint Motion

This study was conducted to determine whether navicular drop, as a representative measure of foot pronation, was associated with first metatarsal joint motion in 24 healthy subjects aged 21 to 40 years. The magnitude of first metatarsophalangeal joint motion was identified using a custom-built weightbearing goniometer designed to measure maximal hallux dorsiflexion in stance. The weightbearing measure of navicular drop was recorded using an adapted digital caliper. Statistical analysis demonstrated a significant negative correlation (P < .05) between the two variables. Furthermore, simple regression analysis suggested that 33.2% of the variation in maximal hallux dorsiflexion could be explained by different navicular drop values.

Outcome of Patients After Achilles Tendon Lengthening for Treatment of Idiopathic Toe Walking

Fifteen children who were diagnosed with idiopathic toe walking that cannot be corrected by nonoperative treatment were assessed by clinical examination and computer-based gait analysis preoperatively and approximately 1 year after Achilles tendon lengthening. Passive dorsiflexion improved from a mean plantarflexion contracture of 8 degrees to dorsiflexion of 12 degrees after surgery. Ankle kinematics normalized, with mean ankle dorsiflexion in stance improving from -8 to 12 degrees and maximum swing phase dorsiflexion improving from -20 to 2 degrees. Peak ankle power generation increased from 2.05 to 2.37 W/kg but did not reach values of population norms. No patient demonstrated clinically relevant triceps surae weakness or a calcaneal gait pattern. Seven patients had a stance phase knee hyperextension preoperatively, and 6 of these corrected after surgery. Achilles tendon lengthening improves ankle kinematics without compromising triceps surae strength; however, plantarflexion power does not reach normal levels at 1 year after surgery.

Reliability and Validity of Visual Assessments of Gait Using a Modified Physician Rating Scale for Crouch and Foot Contact

This study evaluates the visual assessment of gait using portions of the Physicians' Rating Scale (PRS). Thirty children with pathologic gait were evaluated "live" and using full- and slow-speed video. Interobserver reliability (weighted kappa) was 0.57 to 0.74 for foot contact, 0.69 to 0.71 for crouch, 0.30 to 0.40 for hip flexion, 0.57 to 0.65 for knee flexion, and 0.42 to 0.52 for dorsiflexion in stance. Intraobserver reliability (comparing the three conditions) was 0.50 to 0.78 for foot contact, 0.71 to 0.80 for crouch, 0.26 to 0.44 for hip flexion, 0.60 to 0.86 for knee flexion, and 0.39 to 0.61 for dorsiflexion. Observers were correct only 12% to 32% of the time when reporting less than 0 degrees of dorsiflexion and 0% to 29% of the time when reporting more than 20 degrees of hip flexion due to overestimation of hip flexion and underestimation of ankle dorsiflexion. These errors could lead some clinicians to presume the presence of contractures that do not actually exist. Visual assessment using the PRS does not appear to accurately measure what it is most commonly used to assess: ankle position in stance.

Biomechanical changes in gait following selective dorsal rhizotomy

Object. The purpose of this study was to evaluate the effects of selective dorsal rhizotomy (SDR) on the walking pattern of children with cerebral palsy (CP). The authors hypothesized that SDR would reduce the overactive stretch reflex and result in improved joint positions, greater joint angular velocities and motion, and greater strides. The authors also expected that the changes from the SDR would be reflected in the electrical activities of the muscles. Methods. Twenty children with CP participated in the study. Ten underwent SDR and 10 who met the inclusion criteria but who did not undergo SDR formed a control group. Gait analysis was performed twice in both groups at comparable time intervals. Within-group (pre- and post-SDR) assessments and between-group (SDR compared with no SDR) assessments were performed. The results indicated that strides increased 1.4 cm on average (p < 0.001), hip and knee excursion increased as a result of greater hip and knee flexion in swing, and ankle dorsiflexion in stance improved. Hip-flexion and knee-extension velocities were increased in swing. Electromyography changes were consistent with these gait changes and support the authors' hypothesis. Conclusions. By attenuating the stretch response, SDR alters gait mechanics. The effects of SDR include greater strides, joint excursions, and joint angular velocity.

Biomechanical changes in gait following selective dorsal rhizotomy

The purpose of this study was to evaluate the effects of selective dorsal rhizotomy (SDR) on the walking pattern of children with cerebral palsy (CP). The authors hypothesized that SDR would reduce the overactive stretch reflex and result in improved joint positions, greater joint angular velocities and motion, and greater strides. The authors also expected that the changes from the SDR would be reflected in the electrical activities of the muscles. Twenty children with CP participated in the study. Ten underwent SDR and 10 who met the inclusion criteria but who did not undergo SDR formed a control group. Gait analysis was performed twice in both groups at comparable time intervals. Within-group (pre- and post-SDR) assessments and between-group (SDR compared with no SDR) assessments were performed. The results indicated that strides increased 1.4 cm on average (p < 0.001), hip and knee excursion increased as a result of greater hip and knee flexion in swing, and ankle dorsiflexion in stance improved. Hip-flexion and knee-extension velocities were increased in swing. Electromyography changes were consistent with these gait changes and support the authors' hypothesis. By attenuating the stretch response, SDR alters gait mechanics. The effects of SDR include greater strides, joint excursions, and joint angular velocity.

Short‐term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural history

Outcome in 24 ambulant children with spastic diplegic cerebral palsy, in whom multilevel surgical intervention was recommended following gait analysis, is reviewed. Twelve children had surgical intervention (treatment group; eight males, four females; mean age 9 years 10 months, SD 3 years 4 months) while the other 12 did not (control group; five males, seven females; mean age 10 years 1 month, SD 2 years 11 months). All children had interval three‐dimensional gait analyses (mean time between analyses: control group, 14.1 months; treatment group, 17.9 months). At follow‐up the control group (mean age 11 years 9 months) showed a significant increase in minimum hip and knee flexion in stance which was not related to age, the interval between analyses, changes in the passive joint range of motion, nor changes in anthropometric measurements. The treatment group (mean age at follow‐up 11 years 3 months) showed a significant improvement in minimum knee flexion and in ankle dorsiflexion in stance. Parents of nine children said their child's walking distance had increased following intervention. Of five children using posterior walkers preoperatively, two continued to use them postoperatively; two were using crutches or sticks and the remaining child walked independently. Two children who walked independently preoperatively used sticks postoperatively for community ambulation. The deterioration seen in the kinematics of the control group suggests that previous outcome studies comparing postoperative gait with preoperative gait have underestimated the immediate effects of surgery. It also raises concerns about the long‐term effects of surgical intervention.

Treatment for Idiopathic Toe-Walking

Thirteen skeletally mature subjects who had been treated as children for idiopathic toe-walking underwent gait analysis and calf muscle strength testing at an average of 10.8 years from the last intervention. Six had had serial casting only; seven had had either a percutaneous tendo Achilles lengthening or a Baker's gastroc-soleus lengthening. Sagittal plane kinematics at the ankle was altered in 12 of the 13 subjects, but the changes were detectable visually in only 3 subjects. One subject had increased ankle plantarflexion at initial contact, but the other 12 subjects had a normal first rocker. Peak ankle dorsiflexion in stance averaged only 9 degrees, and 11 of the subjects had a peak ankle dorsiflexion in stance greater than 2 standard deviations below normative values. Ankle dorsiflexion was also restricted on passive measures, but there was no correlation between ankle dorsiflexion non-weight-bearing and in gait. Inversion of second rocker was seen in two subjects with peak ankle dorsiflexion in stance occurring before 25% of the gait cycle. Power generation by the calf during a single heel-rise test was variable between subjects but within normative values compared with controls. The authors conclude that most subjects showed persistent changes in ankle kinematics and kinetics despite treatment but that this was not detectable visually in most subjects.

Treatment for Idiopathic Toe-Walking

Thirteen skeletally mature subjects who had been treated as children for idiopathic toe-walking underwent gait analysis and calf muscle strength testing at an average of 10.8 years from the last intervention. Six had had serial casting only; seven had had either a percutaneous tendo Achilles lengthening or a Baker's gastroc-soleus lengthening. Sagittal plane kinematics at the ankle was altered in 12 of the 13 subjects, but the changes were detectable visually in only 3 subjects. One subject had increased ankle plantarflexion at initial contact, but the other 12 subjects had a normal first rocker. Peak ankle dorsiflexion in stance averaged only 9°, and 11 of the subjects had a peak ankle dorsiflexion in stance greater than 2 standard deviations below normative values. Ankle dorsiflexion was also restricted on passive measures, but there was no correlation between ankle dorsiflexion non-weight-bearing and in gait. Inversion of second rocker was seen in two subjects with peak ankle dorsiflexion in stance occurring before 25% of the gait cycle. Power generation by the calf during a single heel-rise test was variable between subjects but within normative values compared with controls. The authors conclude that most subjects showed persistent changes in ankle kinematics and kinetics despite treatment but that this was not detectable visually in most subjects.

A methodology for studying the effects of various types of prosthetic feet on the biomechanics of trans-femoral amputee gait

This paper reports on a methodology developed for studying the effects of various types of prosthetic feet on the gait of trans-femoral amputees. It is shown that an analysis in three planes of motion of not only the prosthetic, but also the sound limb provides important information on the performance of prosthetic feet. Two male trans-femoral amputees were tested with four different prosthetic feet; the Springlite II, Carbon Copy III, Seattle LightFoot and the Multiflex foot. A detailed analysis of the results of one amputee and a summary of the most important results of a second subject is presented. The tests were carried out at normal (1.16 m s −1) and fast (1.56 m s −1) walking speeds. Three dimensional gait analysis was carried out to derive the time curves of the joint angles, intersegmental moments and power at the ankle, knee and hip joints at both the prosthetic and sound sides. A higher first peak of the ground reaction force at the sound side with the Seattle LightFoot compared to that with the Springlite II, may be the result of the lower late stance dorsiflexion angle with the former. Compared to the other two feet, the Carbon Copy III and the Springlite II showed higher prosthetic dorsiflexing moments and positive power at late stance, which could assist in the push-off. The 3D intersegmental loads at the ankle and knee can be used as a guide for design and for compilation of standards for testing of lower limb prostheses incorporating flexible feet.

Conservative options in the management of spasticity in children with cerebral palsy — Stretching serial casts and orthoses

Patients with spastic Cerebral Palsy are prone to equinus deformities, likely affected by short and inextensible plantarflexor muscles. Manual stretching is a popular treatment but its effectiveness concerning joint mobility, muscle-tendon morphometrics and walking function is debated. Eccentric exercise by backward-downhill treadmill training could be a therapeutic alternative for ambulatory patients improving gait and muscle function.What are the effects of eccentric training by backward-downhill treadmill training and plantarflexor stretching concerning gait and muscle function in patients with spastic Cerebral Palsy?10 independent ambulators with spastic Cerebral Palsy (12 [SD 4] years old, 2 uni- and 8 bilaterally affected) participated in a randomized crossover-study. One group started with manual static stretching, the other one with backward-downhill treadmill training. Each treatment period lasted 9 weeks (3 sessions per week). Pre and post treatments, 3D gait was assessed during comfortable and during fastest possible walking. Ultrasonography and dynamometry were used to test plantarflexor strength, passive joint flexibility, as well as gastrocnemius morphometrics, stiffness and strain on muscle-tendon and joint level.When comparing both treatments, backward-downhill treadmill training lead to larger single stance dorsiflexion at comfortable walking speed (+2.9°, P = 0.041) and faster maximally achievable walking velocities ( + 0.10 m/s, P = 0.017). Stretching reduced knee flexion in swing, particularly at faster walking velocities (-5.4°, P = 0.003). Strength, ankle joint flexibility, as well as stiffness on muscle-tendon and joint level were not altered, despite similar increases in passive muscle and fascicle strain with both treatments (P ≤ 0.023).Backward-downhill treadmill training can be an effective gait treatment, probably improving coordination or reducing dynamic stretch sensitivity. More intense BDTT might be necessary to further alter muscle-tendon properties. Manual static plantarflexor stretching may not be optimal in Cerebral Palsy patients with high ambulatory status.

Lower limbs rotational abnormalities consequences on angular parameters in children walking

This paper reports on a methodology developed for studying the effects of various types of prosthetic feet on the gait of trans-femoral amputees. It is shown that an analysis in three planes of motion of not only the prosthetic, but also the sound limb provides important information on the performance of prosthetic feet. Two male trans-femoral amputees were tested with four different prosthetic feet; the Springlite II, Carbon Copy III, Seattle LightFoot and the Multiflex foot. A detailed analysis of the results of one amputee and a summary of the most important results of a second subject is presented. The tests were carried out at normal (1.16 m s−1) and fast (1.56 m s−1) walking speeds. Three dimensional gait analysis was carried out to derive the time curves of the joint angles, intersegmental moments and power at the ankle, knee and hip joints at both the prosthetic and sound sides. A higher first peak of the ground reaction force at the sound side with the Seattle LightFoot compared to that with the Springlite II, may be the result of the lower late stance dorsiflexion angle with the former. Compared to the other two feet, the Carbon Copy III and the Springlite II showed higher prosthetic dorsiflexing moments and positive power at late stance, which could assist in the push-off. The 3D intersegmental loads at the ankle and knee can be used as a guide for design and for compilation of standards for testing of lower limb prostheses incorporating flexible feet.

Gait changes in children with spastic diplegia after selective dorsal rhizotomy.

Twenty-six ambulatory children underwent preoperative and 1-year postoperative assessments after selective dorsal rhizotomy. These included spasticity, passive range of motion, tone, three-dimensional motion analysis, and electromyography. Independent and dependent ambulators were evaluated separately. A decrease in spasticity was found in all lower extremity muscle groups. An increase in passive range of motion was found only at the hip for both independent and dependent ambulators. Gait changes included increases in velocity and stride length in the independent ambulators. An improvement in hip extension during stance was found in the dependent ambulators only; however, an increase in knee extension and dorsiflexion in stance were seen in both groups. Selective dorsal rhizotomy improves both passive and dynamic range of motion in children with spastic diplegia.

Z-Bunionectomy: Retrospective long-term study

Long-term patient satisfaction and objective clinical and radiographic examinations of patients who had undergone the Z-bunionectomy at the University of Chicago Medical Center were evaluated. Fifty-six surgeries were performed on 31 patients, with a follow-up range of 5 to 9 years. The University of Maryland 100-Point Painful Foot Center Scoring System was modified to be more specific to bunion surgery, and we used this modification to measure patient satisfaction. Patient satisfaction was rated good to excellent by 90% of the patients. Radiographic findings included: intermetatarsal angle-mean, 7.1 degrees; hallux abductus angle-mean, 8.96 degrees; tibial sesamoid position-mean, 2.8. The mean protrusion was -1.64 mm. Radiographic findings consistent with osteonecrosis were noted of one patient, one foot, although the patient was clinically asymptomatic. The objective findings were as follows: dorsiflexion, mean, 60 degrees; plantarflexion, mean, 14 degrees. No patients had pain or crepitus, nor were they tract-bound in their first metatarsophalangeal joint range of motion. In addition, stance dorsiflexion had a mean of 21 degrees, and the purchase power was 88% good to excellent on plantar paper pull-out testing. First ray motion qualitatively demonstrated 1 1/2 to 2 times dorsiflexion to plantarflexion. There were no subsecond metatarsal head keratoses. Generalized ligamentous laxity was not seen. For the resting calcaneal stance position the mean was 3.5 degrees everted, with 24% of the patients maximally pronated in this position. We were unable to correlate any structural and functional postoperative features with patient satisfaction.

Influence of prosthetic foot design on sound limb loading in adults with unilateral below-knee amputations

Altered gait patterns resulting from amputation has been implicated as a possible mechanism for early degenerative changes in the sound limb of unilateral amputees. The purpose of this study was to examine the ground reaction force characteristics and joint motion in this population. Ground reaction forces, joint motion, and stride characteristics of 10 traumatic below-knee amputees were analyzed while waring five different prosthetic feet (SACH, Flex-foot, Carbon Copy II, Seattle, and Quantum). Subjects used each foot for 1 month prior to testing. Results indicated that the Flex-foot significantly reduced the initial peak of the vertical ground reaction force on the sound limb compared to all other feet tested (p < .0001). The SACH foot consistently produced the greatest ground reaction forces on the sound limb; however, this was not statistically significant. The effective factor of the Flex-foot appears to be minimization of the center of gravity elevation, which was accomplished through a significant increase in terminal stance dorsiflexion compared to the other feet tested (p < .0001).

Kinematic analysis of gait before and after heel cord lengthening for idiopathic toe walking

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.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.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.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.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.