Ann Rehabil Med.  2011 Jun;35(3):344-353. 10.5535/arm.2011.35.3.344.

The Effect and Complication of Botulinum Toxin Type A Injection with Serial Casting for the Treatment of Spastic Equinus Foot

• Lee SJ
• Sung IY
• Jang DH
• Yi JH
• Lee JH
• Ryu JS

• KMID: 2266853
• DOI: http://doi.org/10.5535/arm.2011.35.3.344

Abstract

OBJECTIVE
To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot. METHOD: Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modified Tardieu scale (MTS). Gait pattern was measured using the physician's rating scale (PRS).
RESULTS
The degree of ankle dorsiflexion and the MAS improved significantly until 12 weeks following the BTX-A injection in the serial casting group (p<0.001), while the BTX-A injection-only group improved until 6 weeks following injection (p<0.05). The combined group showed a significantly greater increase in the degree of dorsiflexion compared to the BTX-A injection-only group at post-injection weeks 6 and 12 (p<0.05). Three children (11.5%) suffered from foot ulcers as a complication caused by the serial casting.
CONCLUSION
Our study demonstrated that the effect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.

Keyword

Cerebral palsy; Equinus foot; Botulinum toxin type A; Serial casting

MeSH Terms

Ambulatory Care Facilities
Animals
Ankle
Ankle Joint
Botulinum Toxins
Botulinum Toxins, Type A
Cerebral Palsy
Child
Foot
Foot Ulcer
Gait
Humans
Muscle Spasticity
Botulinum Toxins
Botulinum Toxins, Type A

Figure

• 

  Fig. 1 Serial casting (A) A layer of stockinette was applied over foot and calf. (B) Cotton roll was applied. (C) Fibergrass walking cast (NEAL CAST®, BLTEH, Korea) was applied with the ankle in maximal passive dorsiflexion.

• 

  Fig. 2 Changes of dynamic component in both groups, (A) Changes in Botulinum toxin A injection with casting group. (B) Changes in Botulinum toxin A injection group*p<0.05 by Freidman test, Post hoc test, †p<0.0083 significant difference between baseline and post injection 3 wks, ‡p<0.0083 significant difference between baseline and post injection 6 wks, §p<0.0083 significant difference between baseline and post injection 12 wks, ¶p<0.0083 significant difference between post injection 3 wks and 6 wks.

• 

  Fig. 3 Changes between post & pre-injection, (A) Changes between post-injection 3 weeks and pre-injection, (B) Changes between post-injection 6 weeks and pre-injection. The changes were larger for ΔR2 degree in the injection with cast group than the injection only group. *p<0.05 by Mann-Whitney U test.

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