The Management of Toe Walking in Children with Autism Spectrum Disorder: "Cast and Go"

• Published in: Children (Basel) Vol. 9; no. 10; p. 1477
• Main Authors: Manfredi, Francesco, Riefoli, Flavia, Coviello, Michele, Dibello, Daniela
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 27-09-2022; MDPI
• Subjects: Ankle; Autism; Autistic children; Behavior; Bone surgery; Botulinum toxin; Children & youth; Communication; Disease; Families & family life; Foot diseases; Gait; Genetic disorders; Hospitals; Mental disorders; Neuromuscular diseases; Orthopedics; Patients; Pediatrics; Physical therapy; Questionnaires; serial casting; Social interaction; Tendons; toe walking; Walking; botulinum toxin; serial casting; toe walking; autism
• ISSN: 2227-9067; 2227-9067
• DOI: 10.3390/children9101477

Background: Toe walking is associated with autism spectrum disorders (ASD). Correction of this “behavior” is a health challenge. The toe walker is affected by the contact refusal with the outside world: touching the ground as little as possible, trying to avoid any contact. A structured equines foot is a possible consequence. Method: We present the “Cast and Go” protocol, used in 22 idiopathic toe walker children with ASD treated from 2015 to 2020. The treatment was performed by a single senior experienced doctor with botulinum injection, ankle casts and rehabilitative therapies. All patients underwent pre- and post-treatment clinical evaluation using ankle dorsiflexion angle and casting number as treatment. We aimed to identify the intervention with the shortest acquisition time for the management of toe walking. Results: Our findings demonstrated the baseline ankle dorsiflexion angle influenced the casting number (p < 0.01) and male patients had a higher baseline ankle dorsiflexion angle than female patients (p < 0.01). No adverse events were observed. Conclusions: These findings suggested that the “Cast and Go” protocol could be a promising, dynamic and effective practice for toe walking disease in ASD patients.