PMC4762432_01
A 5-year-old boy with severe ITW before TIC treatment (A) and 3 months after cast removal (B).. Abbreviations: ITW, idiopathic toe walking; TIC, tone-inhibiting cast.
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In addition, bilateral Achilles' tendon contracture developed, both forefeet were splayed, and a disproportionately wide forefoot was observed compared with the heel and external tibial torsion, which frequently develops to compensate for the lack of a flat foot contact (Figure 1A). The foot-flat position and heel contact with the ground were maintained for both legs during standing, as shown in Figure 1B.
Tone-inhibiting casts on a 5-year-old boy with severe ITW.. Abbreviation: ITW, idiopathic toe walking.
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An inhibition bar on both casts was used to reduce the stimulus to the reflexogeneous area of both the toe-grasping reflex of the foot and the support reflex of legs (Figure 2).
Deficit of the ROM of ankle dorsiflexion with the knee extended for the right and left lower limbs in a 5-year-old boy with severe ITW.. Abbreviations: ROM, range of motion; ITW, idiopathic toe walking; T1L, deficit of ankle dorsiflexion (knee extended) of left lower limb; T1R, deficit of ankle dorsiflexion (knee extended) of right lower limb.
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The precast examination revealed a large deficit of ROM of aDF, defined as the value from the neutral foot position in both tests (Figures 3 and 4). Improvements in ankle ROM and its maintenance at the 6- and 9-month post-casting examinations are shown in Figures 3 and 4.
Deficit of the ROM of ankle dorsiflexion with the knee flexed at 90  for the right and left lower limbs in a 5-year-old boy with severe ITW.. Abbreviations: ROM, range of motion; ITW, idiopathic toe walking; T2L, deficit of ankle dorsiflexion (knee flexed 90 ) of left lower limb; T2R, deficit of ankle dorsiflexion (knee flexed 90 ) of right lower limb.
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The precast examination revealed a large deficit of ROM of aDF, defined as the value from the neutral foot position in both tests (Figures 3 and 4). Improvements in ankle ROM and its maintenance at the 6- and 9-month post-casting examinations are shown in Figures 3 and 4.
GGI values for the right and left lower limbs in a 5-year-old boy with severe ITW.. Note: GGI values for normally developing children range from 8.2 to 26.9.. Abbreviations: GGI, Gillette Gait Index; ITW, idiopathic toe walking; L, left lower limb; R, right lower limb.
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GGI calculation (80.1 for the right and 92.7 for the left lower limb) revealed a strong deviation of the patient's gait from a normal gait pattern (Figure 5). GGI values for typically developing children range from 8.2 to 26.9. A significant improvement in the gait pattern (confirmed by the GGI) did not appear immediately, but it was apparent at 6 weeks after cast removal (Figure 5). The evolution of the subject's gait pattern, as indicated by the GGI, is shown in Figure 5. Although the final GGI values were not completely characteristic of a normal gait, the GGI values at 3, 6, and 9 months post casting were constant and close to those of normally developing children (Figure 5).