Repeated botulinum toxin A injections in the treatment of spastic equinus foot.

Equinus foot disorder is a common problem for patients with cerebral palsy who are able to ambulate. Botulinum toxin A is a recommended method of treatment for temporary reduction of muscle tone. The efficacy of repeated botulinum toxin A injections in the calf muscles was evaluated in a clinical trial involving 21 children with cerebral palsy and dynamic equinus foot deformity who were able to ambulate. The mean age of the children was 5.7 years. All patients received at least two injections, six patients received at least three injections, and three patients received four injections. The outcome was evaluated using observational and three-dimensional instrumented gait analysis. Significant improvements of the gait parameters were observed at 6 and 18 weeks after the first and second injections. Botulinum toxin A injections in gastrocnemius and soleus muscles may change the natural history of equinus foot deformity in patients with spastic diplegia. Orthopaedic surgery may be postponed or avoided.