Efficacy of A-type Botulinum Toxin on Children with Equinus Foot Classified by the Plantarflexor – knee Extension Couple Index: A Retrospective Study
International Journal of Neurorehabilitation
and Aim: Botulinum toxin is often adopted as a treatment for muscle spasticity and toe walking in children with several palsy. Efficacy and long-term effect of botulinum toxin are currently discussed in the literature as the effects may vary depending on the subject. The aim of this work was to study the efficacy of botulinum toxin treatment on toe-walkers with different walking patterns. Methods: The analysis was conducted on children diagnosed with diplegia related to cerebral palsy. The
... ral palsy. The walking patterns were classified according to the plantarflexor-knee extension couple index. Deviation in gait patterns and changes post-treatment were quantified by summary measures based on kinematics in order to evaluate the overall effect. Outcomes: Three motor phenotypes were identified: (i) Bilateral true equinus, (ii) Bilateral jump gait, (iii) Asymmetric gait. Bilateral true equinus and bilateral jump gait subjects had a post-treatment improvement at the ankle joint but no improvement in the overall gait. The subjects with asymmetric gait did not benefit from the treatment. Conclusions and Implications: This study showed that botulinum toxin had its main effect locally rather than on the overall gait. Both phenotypes of equinus foot (bilateral true equinus and bilateral jump gait) are good candidates for this treatment. The treatment of toe-walkers subjects with botulinum toxin is recommended only if a localized and temporary effect is desired.