title: The effect and complication of botulinum toxin type a injection with serial casting for the treatment of spastic equinus foot.
abstract: OBJECTIVE
  To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot.
  
  
  METHODS
  Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modified Tardieu scale (MTS). Gait pattern was measured using the physician's rating scale (PRS).
  
  
  RESULTS
  The degree of ankle dorsiflexion and the MAS improved significantly until 12 weeks following the BTX-A injection in the serial casting group (p<0.001), while the BTX-A injection-only group improved until 6 weeks following injection (p<0.05). The combined group showed a significantly greater increase in the degree of dorsiflexion compared to the BTX-A injection-only group at post-injection weeks 6 and 12 (p<0.05). Three children (11.5%) suffered from foot ulcers as a complication caused by the serial casting.
  
  
  CONCLUSIONS
  Our study demonstrated that the effect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.
authors.affiliation: Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Sook Joung
authors.initials: SJ
authors.lastname: Lee
authors.forename: In Young
authors.initials: IY
authors.lastname: Sung
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Jang
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Yi
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Ju Seok
authors.initials: JS
authors.lastname: Ryu