Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: A randomised prospective trial

Conservative therapies for equinus in cerebral palsy may help to postpone c alf surgery in younger children. This study reports a prospective randomise d trial of intramuscular botulinum toxin A (BtA) as an alternative to seria l casting in 20 children with a dynamic component to calf equinus. Outcome was assessed in the short term to show the effect of one treatment cycle. A ssessments were by clinical examination, video gait analysis, and three-dim ensional gait analysis. BtA was of efficacy similar to that of serial casti ng. Tone reduction in the BtA group allowed a more prolonged improvement in passive dorsiflexion, which may allow more opportunity for increase in mus cle length. Gait analysis showed an improved mean ankle kinematic pattern i n a subsection of both groups, which was maintained at 12 weeks in the BtA group, whereas the cast group relapsed. There were fewer side effects in th e BtA group. Median time to reintervention was similar.