title: Efficacy of Botulinum Toxin A Treatment for Pes Varus during Gait.
abstract: BACKGROUND
  The efficacy of botulinum toxin A (BoNTA) injection on spasticity is usually measured using Modified Ashworth Scale (MAS), but this only evaluates muscle tone at rest and has poor reliability. There are no reports that quantitatively evaluate pes varus during walking after botulinum treatment. The purpose of this study was to evaluate the efficacy of BoNTA injection on pes varus during gait using 3-dimensional motion analysis.
  
  
  METHODS
  Twenty-four hemiplegic patients with spastic pes varus deformity during gait received BoNTA injection into lower limb muscles. MAS score, comfortable overground gait velocity, and pes varus angle during treadmill walking were evaluated before, 2, 6, and 12 weeks after the injection. Five healthy subjects were also recruited to develop the pes varus/valgus angle as a normal reference.
  
  
  RESULTS
  The median MAS scores were significantly lower at 2 and 6 weeks after the injection. The maximum pes varus angle during the swing phase was significantly lower at 2, 6, and 12 weeks after the injection. It was significantly lower at 6 weeks after the injection during stance phase. The comfortable overground gait velocity was also improved after the injection. However, 2 patients experienced pain during gait and their pes varus angle increased during the follow-up period.
  
  
  CONCLUSIONS
  BoNTA injection improved pes varus angle during gait. Evaluating motion in addition to spasticity at rest is recommended because improvements in limb function do not always parallel improvements in spasticity at rest.
authors.affiliation: Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan. Electronic address: tanikawa@fujita-hu.ac.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tanikawa
authors.affiliation: Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kagaya
authors.affiliation: Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Saitoh
authors.affiliation: Department of Rehabilitation Medicine, National Hospital for Geriatrics Medicine, Obu, Aichi, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ozaki
authors.affiliation: Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.affiliation: Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
authors.forename: Norihide
authors.initials: N
authors.lastname: Itoh
authors.affiliation: Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Yamada
authors.affiliation: Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Kanada
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000188:drug therapy* / Q000209:etiology*; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin A; gait analysis; hemiplegia; pes varus; spasticity; treadmill