Efficacy of Botulinum Toxin A Treatment for Pes Varus during Gait

Tanikawa, Hiroki; Kagaya, Hitoshi; Saitoh, Eiichi; Hirano, Satoshi; Itoh, Norio; Yamada, Junya; Kanada, Yoshikiyo

doi:10.1016/j.jstrokecerebrovasdis.2015.06.035

Cited by 11 publications

(7 citation statements)

References 32 publications

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“…However, management of tibialis anterior muscle spasticity has been controversial. Targeting this muscle is included in the treatment decision-making algorithm by one group of clinicians [ 2 ], but it is not considered by other groups [ 11 , 22 ]. As demonstrated in Figure 3 , successful suppression of tibialis anterior muscle spasticity contributes to correction of the varus deformity.…”

Section: Discussionmentioning

confidence: 99%

Ankle and Foot Spasticity Patterns in Chronic Stroke Survivors with Abnormal Gait

2020

Toxins

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Chronic stroke survivors with spastic hemiplegia have various clinical presentations of ankle and foot muscle spasticity patterns. They are mechanical consequences of interactions between spasticity and weakness of surrounding muscles during walking. Four common ankle and foot spasticity patterns are described and discussed through sample cases. The patterns discussed are equinus, varus, equinovarus, and striatal toe deformities. Spasticity of the primary muscle(s) for each deformity is identified. However, it is emphasized that clinical presentation depends on the severity of spasticity and weakness of these muscles and their interactions. Careful and thorough clinical assessment of the ankle and foot deformities is needed to determine the primary cause of each deformity. An understanding of common ankle and foot spasticity patterns can help guide clinical assessment and selection of target spastic muscles for botulinum toxin injection or nerve block.

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Section: Discussionmentioning

confidence: 99%

Ankle and Foot Spasticity Patterns in Chronic Stroke Survivors with Abnormal Gait

2020

Toxins

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“…In particular, the continuous contraction of the triceps surae muscle can lead to clonus, which, in turn, may result in an equinovarus foot [5]. An equinovarus foot can result in poor toe clearance during the swing phase of gait and ankle instability during weight bearing [6]. Botulinum toxin A therapy (BoNT-A) temporarily reduces muscle activity by preventing the release of acetylcholine at the neuromuscular injection, resulting in a reduced spasticity and muscle tone [7].…”

Section: Introductionmentioning

confidence: 99%

Botulinum Toxin Therapy Combined with Rehabilitation for Stroke: A Systematic Review of Effect on Motor Function

Hara

Momosaki

Niimi

et al. 2019

Toxins

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Aim: The purpose of this study was to examine the effectiveness of botulinum toxin A (BoNT-A) therapy combined with rehabilitation on motor function in post-stroke patients. Methods: The following sources up to December 31, 2018, were searched from inception for articles in English: Pubmed, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL. Trials using injections of BoNT-A for upper and lower limb rehabilitation were examined. We excluded studies that were not performed for rehabilitation or were not evaluated for motor function. Results: Twenty-six studies were included. In addition to rehabilitation, nine studies used adjuvant treatment to improve spasticity or improve motor function. In the upper limbs, two of 14 articles indicated that significant improvement in upper limb motor function was observed compared to the control group. In the lower limbs, seven of 14 articles indicated that significant improvement in lower limb motor function was observed compared to the control group. Conclusions: The effect of combined with rehabilitation is limited after stroke, and there is not sufficient evidence, but results suggest that BoNT-A may help to improve motor function. In future studies, the establishment of optimal rehabilitation and evaluation times of BoNT-A treatment will be necessary for improving motor function and spasticity.

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“…Significant increases in the maximum plantar contact area on the paralyzed side were observed 4 weeks after the first dose and 4 weeks after the second dose. The methods of quantitatively assessing pes equinovarus after botulinum therapy include using a plantar pressure distribution sensor to perform measurements in the standing position [17], measuring the ratio of maximum plantar contact areas during walking using a sheet-type plantar pressure sensor [18], and using a 3-dimensional motion analyzer [19]. However, previous studies analyzed the comparisons before and after a single dose.…”

Section: Discussionmentioning

confidence: 99%

Effect of two doses of botulinum toxin type A on maximum plantar contact area in hemiplegic stroke patients with pes equinovarus

Wada

Otsuka

Kawate

et al. 2020

Jpn J Compr Rehabil Sci

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Inoue Y. Effect of two doses of botulinum toxin type A on maximum plantar contact area in hemiplegic stroke patients with pes equinovarus. Jpn J Compr Rehabil Sci 2020; 11: 85-90. Objectives: To quantitatively demonstrate the therapeutic effects of two doses of botulinum toxin type A (BoNT-A) on pes equinovarus in hemiplegic stroke patients. Methods: The subjects of this study included eight chronic stroke patients who received two BoNT-A doses (mean dose interval: 136.0 (10.5) days) from April 2011 to March 2013 and underwent a sheet-type weight-bearing lower limb test. The maximum plantar contact area on the paralyzed side, ratio of maximum plantar contact areas on the paralyzed and nonparalyzed sides, and Modified Ashworth Scale (MAS) were measured before BoNT-A administration and 4 weeks after both the first and second doses. Results: A significant increase in the maximum plantar contact area was observed after administration of the second dose compared to that of the first dose on the paralyzed side. Additionally, a significant increase was observed in the ratio of paralyzed/non-paralyzed maximum plantar contact areas after the administration of both the first and second doses compared to that before BoNT-A administration. MAS was observed to decline significantly after the administration of both the first and second doses compared to that prior to BoNT-A administration. Conclusions: We suggest that comparison of the plantar contact area is useful for assessing the therapeutic effects of BoNT-A doses on pes equinovarus in hemiplegic stroke patients.

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Efficacy of Botulinum Toxin A Treatment for Pes Varus during Gait

Cited by 11 publications

References 32 publications

Ankle and Foot Spasticity Patterns in Chronic Stroke Survivors with Abnormal Gait

Ankle and Foot Spasticity Patterns in Chronic Stroke Survivors with Abnormal Gait

Botulinum Toxin Therapy Combined with Rehabilitation for Stroke: A Systematic Review of Effect on Motor Function

Effect of two doses of botulinum toxin type A on maximum plantar contact area in hemiplegic stroke patients with pes equinovarus

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