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ABSTRACT: Background: Treatment of older patients with idiopathic toe walking (ITW) can be challenging. Percutaneous Achilles tendon lengthening (pTAL) restores a normal gait pattern for younger children with ITW, but outcomes for older children are unclear. Concern exists that Achilles tendon lengthening in older children may cause residual calf weakness. Methods: We retrospectively evaluated 19 ITW patients older than 10 years of age who were treated with pTAL from 2001 to 2022, 17 of whom had documented ankle equinus with the knee in both extension and flexion in the clinic and in the operating room under anesthesia. Primary outcomes were absence of surgical complications, restoration of ankle motion and normal heel-toe gait pattern, and the ability to voluntarily toe walk and heel walk. Secondary outcomes were residual symptoms, limitations in mobility, use of regular shoewear, and self-reported parent satisfaction with the surgical procedure. Results: Mean age at time of surgery was 12.6 years (range 10–17 years), and average follow-up was 30.3 months (range 11.3–129 months). Seventeen patients (89%) had an Achilles tendon contracture pre-operatively, while two patients had passive ankle motion to neutral position with the knee in flexion. At final follow-up, fourteen patients reported no involuntary toe-walking; five patients reported occasional involuntary toe walking. All patients could voluntarily walk on toes and heels, had active ankle dorsiflexion at or above neutral, and had returned to full unrestricted activity. Most patients wore regular shoes. All parents reported satisfaction with the surgical procedure. Conclusions: The majority of older ITW patients have an Achilles tendon contracture and pTAL is a safe and effective treatment for these older patients. The procedure restores a normal heel-toe gait with no subjective residual ankle plantarflexion weakness. Key Concepts: (1) Achilles tendon contracture can develop in Idiopathic toe walker (ITW) patients as they age and walk on their toes. (2) Percutaneous achilles tendon lengthening (pTAL) is safe and effective in older ITW patients with or without Achilles contracture. (3) The pTAL procedure in older ITW patients can help restore a normal heel-toe gait with no residual ankle plantarflexion weakness. Level of Evidence: IV

Background:. The purpose of this study was to evaluate the impact of an 8-week remote summer program in supporting underrepresented students interested in orthopaedic surgery. Methods:. We received 115 applications, and a total of 17 students participated in the program (14.8%). Nine faculty mentors were matched with 1 or 2 students each. The program delivered a curriculum from June-August 2021 consisting of (1) weekly instructional courses on research-related topics led by a content expert; (2) weekly faculty lectures discussing topics including orthopaedic topics, diversity in medicine, leadership, and work-life balance; and (3) a research experience paired with a faculty mentor and peer mentor. We surveyed students to measure skill progression, satisfaction, and overall program evaluation. Preprogram/postprogram evaluation, midprogram check-in, and student feedback surveys were collected. Results:. Program participants represented a range of race and ethnic backgrounds, research experience levels, and various geographic locations across the United States. The cohort included a high rate of female (42%) and Black (35%) participants. On average, postprogram survey scores indicated that participants believed that the summer program improved their research skills (9.6 of 10), improved their orthopaedic interest (8.9 of 10), and improved mentorship and networking (9.1 of 10). For feedback surveys, 14 respondents of 15 total responses (93%) felt they were adequately matched to their faculty mentor. Twelve (80%) felt they had realistic deliverables for research projects within the 8-week program. Thirteen (87%) indicated they contributed to an abstract or manuscript as a coauthor. Conclusion:. Our findings indicate that students improved their research skills, interest, and confidence to pursue orthopaedic residency and mentorship/networks in the field. The long-term goal is to improve the accessibility and quality of mentorship for underrepresented students in order to foster an equitable pathway into the field of orthopaedic surgery.