Yonsei Med J.  2016 Mar;57(2):496-504. 10.3349/ymj.2016.57.2.496.

Botulinum Toxin Type A Injection for Spastic Equinovarus Foot in Children with Spastic Cerebral Palsy: Effects on Gait and Foot Pressure Distribution

• Choi JY
• Jung S
• Rha DW
• Park ES

• KMID: 2374059
• DOI: http://doi.org/10.3349/ymj.2016.57.2.496

Abstract

PURPOSE
To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot.
MATERIALS AND METHODS
Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection.
RESULTS
Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data.
CONCLUSION
Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.

Keyword

Botulinum toxin type A; equinovarus deformity; cerebral palsy

MeSH Terms

Adolescent
Ankle Joint
Botulinum Toxins, Type A/administration & dosage/*pharmacology
Cerebral Palsy/*complications/drug therapy
Child
Child, Preschool
Clubfoot/*drug therapy/*etiology/physiopathology
Female
Foot
Gait/*drug effects/physiology
Humans
Injections, Intramuscular
Male
Muscle Spasticity/drug therapy
Muscle, Skeletal/diagnostic imaging
Neuromuscular Agents/administration & dosage/*pharmacology
Pressure
Prospective Studies
Treatment Outcome
Weight-Bearing
Botulinum Toxins, Type A
Neuromuscular Agents

Figure

• 

  Fig. 1 Sagittal plane hip, knee, and ankle kinematics. The solid line traces the mean values of 90 normally developing children studied at Severance gait laboratory. The dotted line traces the mean values of the subjects in this study.

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