Idiopathic Toe Walking and Contractures of the Triceps Surae

There is increasing recognition that adult foot pathologies are associated with gastrocnemius shortening. The Silfverskiold test determines whether the equinus deformity is confined to the gastrocnemius. When a stretching program, supervised by a physiotherapist, fails to produce sufficient improvement, surgical release may be considered. Release of gastrocnemius alone is associated with less risk for complication and a shorter rehabilitation, and therefore should be preferred when the Silfverskiold test confirms an isolated contracture of the gastrocnemius. These principles are applicable to adult and pediatric populations.