The use of botulinum type A toxin in the treatment of idiopathic clubfoot: 5-year follow-up.
BACKGROUND
Continued monitoring and reporting of outcomes in clubfoot patients are important for providing an indicator of functional outcomes and surveillance and treatment for problems or recurrences. The purpose of this study is to report the 5-year outcomes of the updated cohort of 44 patients with 65 idiopathic clubfeet treated with manipulation, casting, and Botulinum toxin A (BTX-A).


METHODS
As part of the original study, the patients underwent the corrective treatment phase of manipulation and casting followed with BTX-A injection and then the maintenance phase of bracing. The patients were seen at regular intervals and a detailed clinical history was maintained for each patient including ankle range of motion, recurrences, and interventions for recurrences.


RESULTS
Mean values for range of motion at the 5-year visit were 22.3 and 17.1 degrees for dorsiflexion with the knee in flexion and extension, respectively. Overall, 48% (31 of 65 clubfeet) successfully responded to a single BTX-A injection and experienced no recurrence over the follow-up period. At least 1 repeat BTX-A injection was required in 34 clubfeet, for an overall recurrence rate of 52%. Surgery was required in 10 clubfeet, and the overall surgical rate was 15.4%.


CONCLUSIONS
Idiopathic clubfeet treated with BTX-A continued to show good outcomes at 2 to 5-year follow-up. The experience with this cohort provides support for the effectiveness of BTX-A in the initial correction and continued management of idiopathic clubfoot.


METHODS
Levels III to IV. This is a prospective, nonexperimental clinical study investigating efficacy of an innovative treatment.
Alvarez
Christine M
CM
Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada. calvarez@cw.bc.ca
De Vera
Mary A
MA
Chhina
Harpreet
H
Williams
Linda
L
Durlacher
Kim
K
Kaga
Serap
S
D000843:Ankle Joint / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000503:physiopathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A