A comparative randomized-controlled trial of serial casting and exercises on ankle range of motion, toe walking severity, walking balance, and functional health-related quality of life in children with idiopathic toe walking

Randomized-controlled trials (RCTs) investigating nonoperative interventions for idiopathic toe walking (ITW) are limited. High-quality, parallel-group RCTs comparing treatment with no treatment are needed. This study aimed to assess the effects of serial casting and exercise interventions on ITW, compared with a control group. Children with ITW aged 3-10 years were randomized into the serial casting ( n = 10), the exercise ( n = 9), and the wait-list control ( n = 10) groups. Primary outcomes were ankle dorsiflexion range of motion (ROM) and the Toe Walking Severity Scale (TWSS). The secondary outcomes included pediatric outcomes data collection instrument (PODCI), tandem walk test, and satisfaction from treatment. The patients were assessed before treatment, posttreatment, 1-month posttreatment (MPT), 3 MPT, and 6 MPT. The control group was followed up until the 1 MPT assessment. This trial is registered with Clinicaltrials.gov under the number NCT06010485. No differences were found between the treatment groups in ankle ROM and TWSS at any follow-up points. The control group showed less improvement in the TWSS compared with the intervention groups. Both intervention groups demonstrated significant intragroup improvements over time. All groups improved in ankle ROM, TWSS, and the Tandem Walk Scale, but only the intervention groups showed improvements in PODCI scores. Treatment satisfaction was similar among the intervention groups. Both interventions had comparable rates of side effects and adherence. Both treatment groups demonstrated greater effectiveness than the control group, with no significant differences observed between the treatment groups.