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To the Editor.—
Dr Sadjadpour's observation (234:382, 1975) about the causes of toe walking in Duchenne muscular dystrophy certainly requires repeated emphasis and consideration in corrective surgical procedures.Toe walking does, indeed, precede contracture of the heel cords, and the unfortunate use of heel-cord lengthening commonly eliminates kinesiologic postural adjustment of the child, forcing him into braces. If we are to keep the child walking, we cannot eliminate the only compensatory mechanism that he has left. There is certainly good reason to consider iliotibial tract releases and posterial tibial tendon transfers, but there is rarely an indication for heel-cord lengthening procedures in Duchenne muscular dystrophy while the child still ambulates.
Berrol S. Duchenne Muscular Dystrophy. JAMA. 1976;235(12):1212. doi:10.1001/jama.1976.03260380016015