title: Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: Clinical and radiological evaluations in young children.
abstract: BACKGROUND
  In children with cerebral palsy (CP), overactivity of the peroneus longus (PL) muscle is a major contributor to pes planovalgus. This retrospective study assessed whether abobotulinumtoxinA injections into a PL showing premature activity on electromyography (EMG) clinically improved foot morphology in children with CP.
  
  
  METHODS
  Study participants were <6 years old, had a diagnosis of CP, good functional abilities (Gross Motor Function Classification System level 1 or 2), equinovalgus (initial contact with the hallux or head of the first metatarsal) and overactive PL on EMG. The fore-, mid- and hindfoot were evaluated clinically and radiologically before and after injection of abobotulinumtoxinA (6-7 U/kg) into the PL. Radiological data were compared with reference values for children without pes planovalgus.
  
  
  RESULTS
  In total, 16 children (8 males; 10 hemiplegia, 6 diplegia; mean age: 3.2±1.5 years) received treatment. Mean pre-and post-treatment angles in clinical assessment of dorsiflexion of the talocrural articulation did not differ with both knees flexed (24.4±7.5 vs. 22.2±8.0 degrees; P=0.19) or extended (17.2±8.0 vs. 16.6±6.8 degrees; P=0.36). Radiographic data pre-treatment versus reference data revealed forefoot pronation (metatarsal stacking angle 2.1±8.3 vs. 8.0±2.9 degrees; P=0.002), midfoot planus (lateral talo-first metatarsal 28.5±15.0 vs. 13.0±7.5 degrees; P<0.001; talocalcaneal angle 54.6±8.6 vs. 49.0±6.9 degrees; P=0.004) and significantly decreased calcaneus dorsiflexion, without hindfoot equinus (calcaneal pitch angle 7.9±6.0 vs. 17.0±6.0 degrees; P<0.001). After treatment, the metatarsal stacking angle did not differ from reference values (P=0.15). As compared with before treatment, treatment improved mean angles for metatarsal stacking (2.1±8.3 vs. 7.1±3.9 degrees, respectively, P=0.002), lateral talo-first metatarsal and talocalcaneal (both P<0.001), with no change in the hindfoot.
  
  
  CONCLUSIONS
  PL may be an early target for abobotulinumtoxinA treatment in pes planovalgus associated with premature PL activity in children with CP.
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Service de neurologie pédiatrique, CHU Timone Enfants, 13385 Marseille, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France. Electronic address: christophe.boulay@ap-hm.fr.
authors.forename: C
authors.initials: C
authors.lastname: Boulay
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Jacquemier
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Castanier
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France.
authors.forename: H
authors.initials: H
authors.lastname: Giorgi
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Authier
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Pomero
authors.affiliation: Service de neurologie pédiatrique, CHU Timone Enfants, 13385 Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: Chabrol
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Jouve
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Bollini
authors.affiliation: Laboratoire de la Marche, service de chirurgie orthopédique pédiatrique, CHU Timone Enfants, 13385 Marseille cedex 05, France; Institut des sciences du mouvement, Aix Marseille université, UMR CNRS 6233, 13385 Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Viehweger
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000150:complications*; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007866:Leg; D008297:Male; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA
keywords: Botulinum toxin; Cerebral palsy; Children; Peroneus longus; Planovalgus