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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2004 April;55(2):65-71
Botulinum toxin type A in the treatment of dynamic equinus in cerebral palsy
Tirelli A., Artiaco S., Zanchini F.
Department of Orthopedic and Traumatology II University of Naples, Naples, Italy
Aim. Equinus posturing and equinus deformity are common deformities seen in children with cerebral palsy. Treatment usually includes kinesitherapy, orthoses and casts, however, in recent years botulinum toxin type A (BTX-A) has taken an important role in the treatment of this condition. Treatment with BTX-A allows delays in surgery, minimises progress of deformity and avoids risks of its relapse.
Methods. In this study treatment of dynamic equinus with BTX-A, orthoses and casts, integrated with a specific program of kinesitherapy, was assessed in 17 patients with a mean age of 6.8 years.
Results. Following the treatment, most subjects reported an improvement in motor functions. Passive dorsal flexion of the foot was increased in 15 out of 17 patients (88%) and muscular tone of plantar flexors was less than the baseline evaluation in 11 out of 17 patients (65%). An improvement of voluntary dorsal flexion of the foot was achieved in 7 patients (41%) and gait evaluation showed an improvement of foot contact in 11 patients (65%).
Conclusion. It is hoped that future studies can define the factors that influence individual response and magnitude of BTX-A effects. The selection of patients and the rational use of serial casts and orthoses represent the base to plan the conservative treatment of equinus in cerebral palsy and to improve its effectiveness.