title: Botulinum Toxin Type A Injection for Spastic Equinovarus Foot in Children with Spastic Cerebral Palsy: Effects on Gait and Foot Pressure Distribution.
abstract: OBJECTIVE
  To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot.
  
  
  METHODS
  Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection.
  
  
  RESULTS
  Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data.
  
  
  CONCLUSIONS
  Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.
authors: Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Ja Young
authors: JY
authors: Choi
authors: Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Soojin
authors: S
authors: Jung
authors: Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Dong Wook
authors: DW
authors: Rha
authors: Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea. pes1234@yuhs.ac.
authors: Eun Sook
authors: ES
authors: Park
mesh_terms: D000293:Adolescent; D000843:Ankle Joint; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000494:pharmacology*; D002547:Cerebral Palsy / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005528:Foot; D005684:Gait / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D011312:Pressure; D011446:Prospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin type A; cerebral palsy; equinovarus deformity