Background: Serial casting is commonly used to treat a toe walking gait pattern. However, there is limited evidence on its effect on triceps-surae muscle structure and the relationship to changes in ankle range of motion (ROM).
Purpose: To investigate changes in medial gastrocnemius (MG) muscle architecture and ankle ROM pre and post serial casting for children with idiopathic toe walking (ITW), and age- and gender-matched typically developing children (TD).
Method: ITW participants (n=16) underwent assessment immediately pre-, and one-week post, a six-week casting intervention. TD participants (n=17) were assessed on two occasions, seven weeks apart. At maximal ankle dorsiflexion (DF), 2D B-mode ultrasound assessed MG muscle architecture.
Results: At baseline, the ITW group had decreased DF ROM (ITW -0.5°, TD 15.2°, p<0.05) with shorter muscle-tendon length (mean difference 1.7%, p<0.05), and increased muscle thickness (mean difference 0.18cm, p<0.05).
Post-intervention, the ITW group had increased DF ROM (p < 0.05, 14.6°), increased muscle-tendon length (p < 0.05, 3.5%), increased tendon length (p < 0.05, 1.4%), and increased muscle belly length (p < 0.05, 2.0%). Muscle thickness decreased (p < 0.05, 0.12cm). There was no significant difference between ITW and TD at follow-up. Correlations between post-casting changes in DF ROM and MG muscle architecture were weak (r < 0.36).
Conclusion: Children with ITW have a shorter MG muscle-tendon unit, and thicker muscle belly. Casting improves maximal DF ROM and shifts muscle-tendon length, and muscle thickness towards more normal values, however changes in ROM do not correlate with changes in MG muscle architecture.
Implications: It is reassuring for clinicians that casting improves both muscle belly and tendon length. The lack of correlation between ROM and muscle architecture changes may reflect the relatively small changes which occurred in muscle architecture and the possible contribution of other tissues (for example fascial) to ROM.

Background and purpose: Appropriate visual input is crucial in the early years of life to develop effective postural control, by coordinating the body’s three sensory systems – namely visual, vestibular, and somatosensory systems. Strabismus (misalignment of eyes) is a relatively common childhood ophthalmic disorder that can impact on the development of effective postural control. This longitudinal study aimed to investigate changes in sensory weighting for postural control over time in children with and without strabismus.

Methods: Twenty-four children with strabismus (study group) and 22 matched control participants (control group) completed the Sensory Organization Test (SOT), BOT® Balance subscale, and Paediatric Balance Scale at three time points (baseline, 6 and 12 months). SOT of the NeuroCom Smart Equitest® was the primary outcome measure that systematically manipulated the available sensory information on six sensory testing conditions. The key variables of interest were the percentage measure of balance (Equilibrium Score) for each of the six-conditions and a weighted summary score of all the six conditions (Composite Score). The BOT (0-24) and PBS (0-54) consist of a series of balance assessment tasks which were scored numerically on the items and reduced to a summary score.

Results: A significant group effect (between-participants, p<0.001; F statistic ranging between 71.83 and 2701.76) was found for ES of the SOT condition 3 (sway-referenced surround – manipulating the visual information) and condition 4 (sway-referenced support – manipulating peripheral somatosensory information) and composite score when adjusted for age and baseline measures.

Conclusion: The sensory weighting for postural control changes over time in children as they develop, and this reweighting phenomenon is different between children with and without strabismus.

Implications: Findings highlight the importance of considering the difference in sensory weighting in children with strabismus and incorporate sensory reorganisation exercises in any part of rehabilitation when working with people with strabismus.