Purpose: The purpose of this study is to describe the pedobarographic (plantar pressure) profiles of normal children across all ages, with specific focus on young children (< 6 years) and explore age-related changes in foot pressure patterns.

Method: The Tekscan HR Mat^™ system and Research Foot Module were used in a protocol involving a dynamic test of 146 normal children (age range 1.6–14.9 yrs). Using previously described methods1, relative force and timing data were obtained across five foot segments (heel, lateral midfoot, medial midfoot, lateral forefoot, and medial forefoot). An exploratory approach using analysis of variance (ANOVA) techniques followed by Scheffe post-hoc tests were conducted to determine if there were any age-related differences in foot pressure profiles in children across a priori pedobarograph variables: % of stance at initiation at the heel; % of stance at initiation at the medial midfoot; maximum % force at the heel; and maximum % force at the medial midfoot.

Results: Differences in foot force and timing profiles were distinguished across three age groups: 1) Group 1: 5 years. Data shows that with increasing age, force at the heel increases (Group 1: 61.4, Group 2: 66.9, Group 3: 71.9; p-value=0.019). Data also shows that force at the medial midfoot decreases with increasing age (Group 1: 17.7, Group 2: 8.8, Group 3: 4.7; p-value=0.0). Younger children also demonstrate early initiation of force at the medial midfoot compared to older children (Group 1: 5.9, Group 2: 33.5, Group 3: 44.8; p-value=0.0). In children > 5 years, there are no changes in foot forces or timing of forces.

Conclusion: This is the first study to provide a comprehensive description of the pedobarographic profiles of a large sample of normal children across all ages, with specific focus on the young child. Quantifying foot pressure of children will have relevance to clinical decision making.

Purpose: The purpose of this study is to report on the outcomes of children with ITW who received Botulinum A Toxin (BTX-A) as an adjunct treatment to manipulations/casting and maintenance protocol.

Method: ITW severity was classified using gait analysis and defined by the absence of 1^st ankle rocker, early 3^rd rocker and an early and increased first ankle moment¹. Subjects who met the three severity criteria received a single BTX-A injection into both gastrocsoleus and placed immediately in below-knee casts. Casts were changed two weeks later for a total casting period of four weeks. Subjects then entered a maintenance protocol involving use of night splints or articulated ankle-foot-orthotics. Outcome measures collected at all follow-up visits were ankle dorsiflexion with knee in 90° flexion (DFF) and extension (DFE).

Results: Thirteen subjects with severe bilateral ITW participated. Subjects were followed for an average of 48 weeks (range 7 – 168 weeks) post BTX-A injection. Given the variability in subject outcomes, analyses and reporting were stratified according to subjects’ right and left feet. At day of BTX-A, right foot DFF/DFE were 1.7° ± 14.4 and −1.5° ± 13.0 and mean left DFF/DFE were −1.5° ± 12.8 and −6.5° ± 12.1. Immediate improvement following BTX-A (2 weeks) were seen as right foot DFF/DFE were 14.1° ± 10.0 and 6.3° ± 7.7 and left DFF/DFE were 9.6° ± 14.1 and 3.9° ± 10.6. At 4 weeks, right DFF/DFE were 16.6° ± 9.5 and 11.7° ± 9.1 and left DFF/DFE were 13.1° ± 8.6 and 7.3° ± 8.3. At the half-life of BTX-A (12 weeks), right DFF/DFE were 15.2° ± 12.2 and 10.8° ± 10.5 and left DFF/DFE were 15.8° ± 12.4 and 13.0° ± 11.6. At follow-up visits, correction was maintained as right DFF/DFE were 15.6° ± 9.1 and 10.4° ± 10.3 and left DFF/DFE were 16.9° ± 11.2 and 9.8° ± 10.7.

Conclusion: This is the first study to show early outcomes (improved DFF/DFE) following BTX-A injections in ITW and provides evidence for obtaining and maintaining the correction from a single BTX-A injection over a short-term follow-up period.