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The effect of combined serial casting and botulinum toxin-A injection on ankle equinus in children with spastic dilegia Moore, Kelly Stephanie


This prospective study examined the effects of combined serial casting and botulinum toxin A (Btx) with Btx injection alone in children with spastic diplegia over a 24-week period. Outcome was detemined by the Modified Ashworth Scale, ankle and knee joint ranges of motion, GMFM, gait analysis, and calculation of soleus and gastrocnemius muscle lengths. A decrease in ankle plantarflexor tone and increase in passive ankle dorsiflexion were observed 8 weeks post-injection in both groups and persisted in the combined group until 18 weeks. Improvements in gait were observed only in the combined group at 8 weeks post injection. Examination of these data on a case-by-case basis revealed that 2 of the 5 patients in the Btx only group had improvements in gait that were still evident at 18 weeks post-injection. Improvements in gait persisted in the combined treatment group to 24 weeks. It was concluded that combining Btx with serial casting does lead to more persistent improvements than Btx alone and that combining the two treatments has the potential to be effective in more patients than Btx alone.

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