title: Use of botulinum toxin type A in symptomatic accessory soleus muscle: first five cases.
abstract: Symptomatic accessory soleus muscle (ASM) can cause exercise-induced leg pain due to local nerve/vascular compression, muscle spasm, or local compartment syndrome. As intramuscular injections of botulinum toxin type A (BTX-A) can reduce muscle tone and mass, we investigated whether local BTX-A injections relieve the pain associated with symptomatic ASM. We describe five patients presenting peri/retromalleolar exertional pain and a contractile muscle mass in the painful region. Com-pression neuropathy was ruled out by electromyo-graphic analysis of the lower limb muscles. Doppler ultrasonography was normal, excluding a local vascular compression. ASM was confirmed by magnetic resonance imaging. After a treadmill stress test, abnormal intramuscular pressure values in the ASM, confirmed the diagnosis of compartment syndrome only in one patient. All five patients received BTX-A injections in two points of the ASM. The treatment efficacy was evaluated based on the disappearance of exercise-induced pain and the resumption of normal physical and sports activities. After BTX-A injection, exertional pain disappeared and all five patients resumed their normal level of physical and sports performances. Neither side effects nor motor deficits were observed. BTX-A is well tolerated in patients with ASM and could be used as a new conservative therapeutic strategy for the treatment of symptomatic ASM before surgery.
authors.affiliation: Physical and Rehabilitation Medicine Department, Clémenceau University Institute of Rehabilitation, Strasbourg University, Strasbourg, France. marie-eve.isner@chru-strasbourg.fr.|Strasbourg Translational Medicine Federation (FMTS), EA 3072 "Mitochondria, oxidative stress and muscle protection", Strasbourg, France. marie-eve.isner@chru-strasbourg.fr.
authors.forename: M-E
authors.initials: ME
authors.lastname: Isner-Horobeti
authors.affiliation: Physical and Rehabilitation Medicine Department, Clémenceau University Institute of Rehabilitation, Strasbourg University, Strasbourg, France.|Strasbourg Translational Medicine Federation (FMTS), EA 3072 "Mitochondria, oxidative stress and muscle protection", Strasbourg, France.
authors.forename: G
authors.initials: G
authors.lastname: Muff
authors.affiliation: Strasbourg Translational Medicine Federation (FMTS), EA 3072 "Mitochondria, oxidative stress and muscle protection", Strasbourg, France.|Physiology Institute, Medicine Faculty and Hospital, University Hospital, Strasbourg University, Strasbourg, France.
authors.forename: E
authors.initials: E
authors.lastname: Lonsdorfer-Wolf
authors.affiliation: Physiology Institute, Medicine Faculty and Hospital, University Hospital, Strasbourg University, Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Deffinis
authors.affiliation: Strasbourg Translational Medicine Federation (FMTS), EA 3072 "Mitochondria, oxidative stress and muscle protection", Strasbourg, France.|Physiology Institute, Medicine Faculty and Hospital, University Hospital, Strasbourg University, Strasbourg, France.
authors.forename: J
authors.initials: J
authors.lastname: Masat
authors.affiliation: Strasbourg Translational Medicine Federation (FMTS), EA 3072 "Mitochondria, oxidative stress and muscle protection", Strasbourg, France.|Faculty of Sports Sciences, Strasbourg University, Strasbourg, France.
authors.forename: F
authors.initials: F
authors.lastname: Favret
authors.affiliation: Strasbourg Translational Medicine Federation (FMTS), EA 3072 "Mitochondria, oxidative stress and muscle protection", Strasbourg, France.|Faculty of Sports Sciences, Strasbourg University, Strasbourg, France.
authors.forename: S P
authors.initials: SP
authors.lastname: Dufour
authors.affiliation: Strasbourg Translational Medicine Federation (FMTS), EA 3072 "Mitochondria, oxidative stress and muscle protection", Strasbourg, France.|Physiology Institute, Medicine Faculty and Hospital, University Hospital, Strasbourg University, Strasbourg, France.
authors.forename: J
authors.initials: J
authors.lastname: Lecocq
mesh_terms: D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000002:abnormalities* / Q000000981:diagnostic imaging; D009139:Musculoskeletal Abnormalities / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Supernumerary soleus muscle; exercise-induced leg pain; therapeutic intervention