Efficacy of botulinum toxin A, serial casting, and combined treatment for spastic equinus: a retrospective analysis

Abstract

Botulinum toxin type A (BTX‐A), serial casting, and combined treatment for spastic equinus were compared by chart review. Fifty‐five patients with diplegia ( n =21), hemiplegia ( n =17), quadriplegia ( n =6), and other diagnoses ( n =11) were reviewed. Thirty‐one patients had Gross Motor Function Classification System (GMFCS) scores of I or II, 10 had a GMFCS score of III, and eight had GMFCS scores of IV or V (for six there were no available data). Mean age was 7 years 1 month (SD 4 y 8mo). The combined group showed a significantly greater increase in passive range of motion (ROM) of the ankle joint in comparison with BTX‐A alone ( p =0.0002), with a mean of 17° (SD 11.2) versus 5° (SD 6.7), and casting alone showed a significantly greater increase in comparison with BTX‐A alone ( p =0.0001), with a mean of 15° (SD 4.5) versus 5° (SD 6.7). With cast number controlled, change in ROM after casting with and without BTX‐A was not significantly different ( p =0.37). There was no significant difference between casting with or without BTX‐A, and both improved ROM to a greater degree than BTX‐A alone. Casting demonstrated a significantly more robust impact on range of motion than BTX‐A alone.