Preliminary results of the treatment of pes equinus by using botulinum toxin type a

The authors present preliminary results of the treatment of pes equinus in Croatia, in children with cerebral palsy, by using botulinum toxin type A as a neuromuscular blockade. The authors based their own experiences in the application of botulinum toxin type A in the treatment of equinus spastic foot, upon 15 treated children with either hemiplegia or diplegia (range: 3-7 years). The influence of the blocking effects on the patients were followed-up to an average of 14 months. Botox (Allergan, Inc.) injections were administered intramusculary, using sterile 23-25 gauge needles, into the lateral and medial head of m. gastrocnemius at a total dose of 4-7 U/Kg. In two feet, with expressed varus of the hindfoot, an intramuscular injection of Botox was administered at a total dose of 2 U/Kg in m. tibialis posterior. The results of the treatment were evaluated, using ROM assessment and gait analysis by Koman. The patients were clinically tested in the time intervals: before the application, 24 hours after the application of Botox, and every 4 weeks according to the protocol. In all patients, 3 days after the application of Botox the reduction of spasticity and improvements in gait analysis and walk were obvious. In every patient, an intramuscular injection of Botox was readministered at a same total dose in an average of 6 months after the application of the first injection. The positive response lasted on average for up to 4 months. No major side effects or complications were reported. The authors consider that an intramuscular aplication of Botox improves the ROM of an ankle, provides walking stability, protects from the creation of contractures, and postpones a surgical procedure.