The effect of botulinum toxin type A injections on the natural history of equinus foot deformity in paediatric cerebral palsy patients

Abstract

Neuromuscular blockade with botulinum toxin type A (BTX‐A) injections was employed to manage equinus foot deformity in the lower extremities of paediatric cerebral palsy patients. The patients were followed to evaluate the effect of the blockade on lower extremity function and to determine the effect of treatment on the need for tendo‐Achilles lengthening (TAL) surgery. The average length of follow‐up was 3.4 years. Of the 48 patients, 17 (35%) responded to treatment witbin 6 months of initiation of therapy, as determined by a Physician Rating Scale of gait. Overall, 25 (52%) of the 48 patients underwent TAL surgery during the follow‐up period, including eight patients who responded to the BTX‐A treatment. The average age of the patients at the time of surgery was 7 years. This age compares favourably with the age at surgery reported in the recent literature. There were no significant differences by responder status, age, or gender in those patients who did and did not require TAL surgery. No adverse events relating to BTX‐A were reported. These results indicate that patients who respond to BTX‐A treatment have improved physical functioning and gait, and are able to sustain these results long term.