Effects of botulinum toxin type A injection on the walking ability of stroke survivors with spastic foot drop and talipes varus

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Objective To observe the effect of injecting botulinum toxin type A (BTX-A) into the tibialis anterior muscle on spasm and the walking function of stroke survivors with spastic foot drop and strephenopodia. Methods Fifty-six stroke survivors with spastic foot drop and strephenopodia were randomly divided into a tibialis anterior injection group (Group TA) and a conventional injection group (Group CG), each of 28. Both groups had 50 U of BTX-A injected into the medial-lateral heads of the affected gastrocnemius and soleus muscles, and 35 U injected into each of two sites in the tibialis posterior. Group TA was additionally injected with 30 U in the tibialis anterior. Before the injection, as well as 2, 4 and 12 weeks afterward, both groups were evaluated using the modified Ashworth scale (MAS) for the plantar flexors and varus muscle groups, a 10-minute walking test (10 m-WT), a simple Fugl-Meyer assessment (FMA) of the lower limb and a timed up and go test (TUG). Results Before the injection, there were no statistically significant differences in the average MAS, 10 m-WT, FMA or TUG results between the two groups. After 2 weeks, however, the average MAS score of both groups had decreased significantly, and that improvement was maintained at 4 and 12 weeks after the injection. Moreover, 2, 4 and 12 weeks after the injection, significant differences in the average MAS score were observed between the two groups. The average 10m-WT results, FMA scores and TUG times of both groups also improved significantly, but there were significant differences between the two groups′ 10m-WT times and FMA scores after 2 and 4 weeks. Conclusions Injecting a small dose of BTX-A into the tibialis anterior can further relieve spasm in the tibialis anterior muscle and improve the walking ability of stroke survivors with spastic foot drop and strephenopodia. Key words: Stroke; Spasticity; Botulinum toxin type A; Ankles; Gait; Club foot; Foot drop