Acute Monteggia lesions in children.

Six children who were habitual toewalkers were studied using electromyographic techniques. In the initial gait evaluation, the muscle synergy pattern was found to be abnormal during the toe-toe gait as well as during the heel-toe gait. After treatment with casts, each patient had a normal electromyographic pattern during heel-toe gait. Walking on the toes is a normal variation in the gait pattern of children when they first begin to walk 1.4.10 Within three to six months, however, this pattern normally changes from a toe-toe on a toe-heel gait to a heel-toe pattern9 1o Hall and associates described a group of twenty children who were persistent toe-walkers and who had congenitally short heel cords. The children were more comfortable walking on their toes but voluntarily were able to achieve a heel-toe gait. Orthopaedic and neurological examinations of the twenty children in the series revealed no abnormalities except for a bilateral positional equinus deformity which ranged from 30 to 60 degrees. The patients were treated by lengthening of the Achilles tendon. Postoperatively, the children had a normal range of ankle motion and walked normally, although some of the patients who were older at the time of operation occasionally still walked on their toes. * Vanderbilt University School of Medicine, Nashville, Tennessee 37232. t Veterans Administration Hospital, 13 10 Twenty-Fourth Avenue South, Nashville, Tennessee 37203. Tachdjian disagreed with the operative treatment and suggested that passive stretching of the heel cords, gait training, and below-the-knee walking casts were preferable. He maintained that if one on two trials of conservative management failed, then a heel-cord lengthening should be done. Recently at Vanderbilt University Hospital, six children with the same medical history as already mentioned that is, normal development except for limited donsiflexion at the ankle were evaluated and treated. These children were considered to be habitual toe-walkers and were successfully treated conservatively with plaster casts. Pretreatment and post-treatment electromyognaphic gait analysis was performed in order to show the effect of the treatment. Electnomyographic gait patterns of normal children walking on their toes were analyzed for comparison. The results show that the casts not only increased the range of donsiflexion but also changed the muscle synergy pattern from abnormal to normal. In particular, in this article we discuss the diagnosis and treatment of habitual toe-walkers and compare the gait patterns of habitual toe-walkers with those of nonmal children who were asked to walk normally and then on