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Short-term Effects of Botulinum Toxin A and Serial Casting on Triceps Surae Muscle Length and Equinus Gait in Children with Cerebral Palsy

Aims: The aim of the study was to perform a comprehensive analysis of the short-term effects of a standardized high dose of BTXA and serial casting on spastic equinus in children with cerebral palsy. A second goal was to evaluate this short-term effect on muscle lengths of the triceps surae. Materials and methodology: Prospective study on 10 children (17 limbs) with spastic cerebral palsy and equinus gait pattern. Threedimensional kinematic and kinetic gait analysis with muscluloskeletal modelling was used to evaluate preand 10 weeks post-treatment results. The paired Student’s T-test was used for data analysis. Results: Walking velocity and stride length did not change after BTXA application. The maximal ankle angle at the end of single support increased (p = 0.045) which led to a change of the ankle angle slope quotient towards normal positive values (p = 0.001). Abnormal ankle power generation in the first part of single stance changed towards normal (p = 0.012). Notably, the ankle plantarflexor power was not reduced 10 weeks after BTXA injection (p = 0.486). No lengthening of the triceps surae muscles compared to the baseline assessment was found. Conclusions: Beneficial functional changes in ankle kinematics and kinetics after the application of BTXA when combined with serial casting were demonstrated. The results of our study underline the possible differences in effect of BTXA on intrafusal and extrafusal muscle fibres.