title: Treatment of idiopathic clubfoot utilizing botulinum A toxin: a new method and its short-term outcomes.
abstract: A pivotal point in most clubfoot management protocols is Achilles tendon lengthening or tenotomy to address hindfoot deformity. The effectiveness of botulinum A toxin (BTX-A) in attenuating the function of the triceps surae muscle complex as an alternative to tenotomy was investigated. Fifty-one patients with 73 idiopathic clubfeet were recruited. Outcome measures included surgical rate, Pirani clubfoot score, ankle dorsiflexion with knee in flexion and extension, and recurrences. Patients were divided according to age: group 1 (<30 days old) and group 2 (>30 days and <8 months old). Ankle dorsiflexion in knee flexion and extension remained above 20 degrees and 15 degrees, respectively, and Pirani scores below 0.5 following BTX-A injection for both groups. One of the 51 patients required limited posterior release and 9 patients required repeat manipulation and casting plus or minus BTX-A injection. The use of BTX-A as an adjunctive therapy in the noninvasive approach of manipulation and casting in idiopathic clubfoot is a safe and effective treatment.
authors.affiliation: University of British Columbia, Faculty of Medicine, Division of Pediatric Orthopaedics, Department of Orthopaedics, Children's and Women's Hospital of British Columbia, Vancouver, BC, Canada. calvarez@cw.bc.ca
authors.forename: Christine M
authors.initials: CM
authors.lastname: Alvarez
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Tredwell
authors.forename: Sean P
authors.initials: SP
authors.lastname: Keenan
authors.forename: Richard D
authors.initials: RD
authors.lastname: Beauchamp
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Choit
authors.forename: Bonita J
authors.initials: BJ
authors.lastname: Sawatzky
authors.forename: Mary A
authors.initials: MA
authors.lastname: De Vera
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002675:Child, Preschool; D003025:Clubfoot / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A