title: Botulinum toxin improves reduced dorsiflexion after Achilles tendon surgery.
abstract: Generally, outcome after surgical repair of complete Achilles tendon rupture is good. However, some patients have ongoing problems with dorsiflexion of the ankle joint. We report on eight patients, who did not achieve heel contact because of reduced ankle dorsiflexion 5 months after surgical repair of complete Achilles tendon rupture. All patients received at least three cycles of injections with 200-300 units of Botulinum toxin A (BOTOX) into the gastrocnemius and soleus muscle. Weakening of the triceps surae by Botulinum toxin allowed patients to perform the required exercises and to tolerate casting at night. Thus, all patients were able to tolerate plantigrade foot position 9 months after beginning of Botulinum toxin treatment. At final follow-up after 2 years, pain had significantly improved, and a mean dorsiflexion of 21 degrees was reached. In conclusion, treatment of the calf muscles with BOTOX is a safe and effective method to improve restricted dorsiflexion in patients after Achilles tendon repair.
authors.affiliation: Department of Neurology, Justus-Liebig-University Giessen, Am Steg 14, 35392, Giessen, Germany. Iris.Reuter@neuro.med.uni-giessen.de
authors.forename: Iris
authors.initials: I
authors.lastname: Reuter
authors.forename: Olaf
authors.initials: O
authors.lastname: Lorbach
authors.forename: Sabine
authors.initials: S
authors.lastname: Mehnert
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaps
authors.forename: Martin
authors.initials: M
authors.lastname: Engelhardt
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D000843:Ankle Joint; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002370:Casts, Surgical; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000188:drug therapy*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012422:Rupture, Spontaneous; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A