Is. Corry et al., Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: A randomised prospective trial, J PED ORTH, 18(3), 1998, pp. 304-311
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.