Background/Objectives: Idiopathic toe walking (ITW) is a diagnosis of exclusion in children who demonstrate a persistent toe-walking gait without an identifiable underlying neuromuscular or orthopedic pathology. The classification of toe-walking behavior (TWB) in children with Autism Spectrum Disorder (ASD) remains an area of debate, with some considering it a part of the broader ITW spectrum, while others view it as a distinct entity. Children with TWB associated with ASD (Autistic Toe Walking—ATW) present unique clinical challenges. This subgroup exhibits a higher prevalence of toe walking, and their gait patterns are often associated with underlying neurodevelopmental differences, frequently leading to increased resistance to conventional treatment approaches and higher rates of persistence and recurrence. This narrative review aims to summarize the available evidence on interventions for ATW, highlight differences compared to ITW and discuss implications for clinical practice. Methods: A literature search was performed, including articles that addressed interventions for toe walking in children with ASD. Results: The literature is limited and heterogeneous. Identified interventions include physiotherapy, orthoses, botulinum toxin injections, serial casting, and surgical procedures. Evidence of effectiveness is scarce, with most studies consisting of small case series. ATW differs from classic ITW in some aspects of pathophysiology and clinical presentation. Treatment decisions should balance potential benefits with risks, particularly regarding repeated anesthesia exposure during casting versus earlier surgical options. Conclusions: Evidence for managing ATW is limited. While comparisons to ITW may be useful, clinicians must recognize that they present distinct characteristics. Future research should focus on standardized definitions and controlled trials to guide management.

Introduction: Legg-Calvé-Perthes disease (LCPD) is the idiopathic osteonecrosis of the capital femoral epiphysis in children. It is a self-healing condition, and the morphology of the hip may vary according to the severity of the disease, among several other factors. The treatment focuses on attempts to prevent femoral head collapse, obtain functional hip motion recovery, and reduce pain. Osteochondritis Dissecans (OCD) of the femoral head has been reported in 2% to 7% of patients diagnosed with healed LCPD. Although OCD may remain asymptomatic, the osteochondral fragment has the potential to become unstable, evolving into symptoms of pain, locking, catching, and snapping. Case report: We present a case report of a ten-year-old boy with an OCD lesion following LCPD who underwent effective osteochondral fixation through the surgical hip dislocation approach. The patient evolved to excellent functional recovery at 1 year post-operatively. Discussion: The surgical hip dislocation approach allows anatomical fixation of the OCD fragment, as well as improvement of hip biomechanics, decreasing pain, improving range of motion and joint congruency, and preserving the native articular cartilage. It also gives the surgeon the opportunity to assess hip stability, femoroacetabular impingement and labral tears, allowing a wide variety of options for the treatment of the healed LCPD. Level of Evidence IV; Type of study Case Report.

Introduction: The genu recurvatum is characterized by a hyperextension deformity of the knee in the sagittal plane. Among its causes are conditions such as arthrogryposis, cerebral palsy, poliomyelitis, sequelae of tibial tuberosity fracture and some syndromes with generalized joint hypermobility. Treatment of this deformity can be challenging and, to date, aggressive methods such as femur or tibial osteotomies are the most used for its correction. Objective: This study aimed to describe a new surgical technique for correcting genu recurvatum. Methods: This is a prospective clinical study of children who underwent posterior hemiepiphysiodesis of the distal femur with transphyseal screws. Results: The approach proved to be safe and useful for genu recurvatum deformities, with femoral or articular apex. Conclusion: This approach shows great potential for correcting genu recurvatum in the developing skeleton, being an excellent alternative to the more aggressive methods currently used to treat this deformity. Level of evidence IV, Case Series.

Hip dysplasia in cerebral palsy (CP) is a common and severe problem, especially among nonambulatory patients. A likely cause is muscular imbalance and developmental bone changes leading to a progressive extrusion of the femoral head from the acetabulum. The ideal surgical treatment aims to reduce the dislocated hip to improve pain, positioning, and function. The purpose of this study is to clinically and radiographically compare the results of hip reconstructive surgery with or without open reduction in patients with CP and hip dysplasia. A retrospective study was conducted through access to medical records, radiographs, and clinical evaluation of patients with CP who underwent surgical correction of hip dysplasia through hip reconstructive surgery with a minimum of 2 years follow-up. Two surgical techniques were compared: open versus closed reduction. Clinical parameters such as pain, hip abduction, age, follow-up time, and the Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire were used. Radiographic evaluation included dislocation degree (hip status), Reimers migration percentage, and the presence or absence of osteonecrosis. One hundred thirty hips were included in the study, and 23.08% of patients underwent bilateral procedures. Thirty-three percent of patients were classified as gross motor function classification system IV and 67% were gross motor function classification system V. The mean preoperative reimers migration percentage decreased from 77.4% to 7.6% in the open reduction group and from 76.0% to 6.2% in the closed group ( P = .656). Postoperative hip abduction increased from 10° to 25° in the open group and from 13.2° to 24.2° in the closed group ( P = .096). Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire scores showed no significant differences in Sections II, III, and VII. Osteonecrosis occured in 50% of the open group and 45.3% of the closed group ( P = .659). Both techniques were effective and had similar clinical and radiographic outcomes in treating hip dysplasia in patients with CP. Further prospective studies are necessary to clarify the best indications for each technique.

Introduction: Legg-Calvé-Perthes disease is a major cause of hip joint deformities in children. Currently, experimental research is directed at investigating biological therapies, including the use of human dental pulp stem cells (hDPSC), which have not yet been studied for this purpose in swine models. This study aimed to evaluate whether local injection of hDPSC induces bone mineralization in the proximal femoral epiphysis in an experimental model of avascular necrosis of the femoral head in immature pigs.