Szopa Andrzej, Domagalska-Szopa Małgorzata, Gallert-Kopyto Weronika, Kiebzak Wojciech, Plinta Ryszard
Department of Physiotherapy, Medical University of Silesia, Katowice, Kielce, Poland.
Department of Medical Rehabilitation, School of Health Sciences, Medical University of Silesia, Katowice, Kielce, Poland.
Ther Clin Risk Manag. 2016 Feb 10;12:139-46. doi: 10.2147/TCRM.S95052. eCollection 2016.
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.
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.
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.
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.
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.
近期研究报道了多种治疗特发性足尖行走（ITW）的可能性；然而，尚无充分的文献记载。本病例研究的目的是使用吉列步态指数记录一名重度ITW患儿在非手术治疗方案开始后的第三周和第六周前后，以及此后每3个月至1年的步态模式演变情况。这具有重要意义，因为该病例研究表明非手术治疗方案可以作为重度ITW患儿的一种替代治疗方法。
该病例研究涉及一名5岁被诊断为重度ITW的男孩。一名骨科医生建议进行手术治疗，但他的父母拒绝同意。
该受试者参加了一个为期12周的非手术治疗方案，该方案使用抑制肌张力石膏（TICs）并结合基于神经发育治疗原则的物理治疗。治疗方案包括以下内容：1）石膏制备前；2）使用TICs进行治疗；3）去除石膏后的治疗以改善步态模式。
使用TICs治疗后，站立期踝关节背屈活动范围增加，步态几乎恢复正常。该患者停止足尖行走至少1年。
本研究表明应首先考虑非手术治疗，手术方案仅适用于难治性病例；然而，鉴于目前对使用TICs治疗结果的了解不足以及该治疗方式在ITW患儿中的广泛应用，还需要进一步研究。
