Spatiotemporal Gait Analysis and Lower Limb Functioning in Foot Dystonia Treated with Botulinum Toxin

Abstract

Foot dystonia (FD) is a disabling condition causing pain, spasm and difficulty in walking. We treated fourteen (14) adult patients experiencing FD with onabotulinum toxin A injection into the dystonic foot muscles. We analyzed the spatiotemporal gait utilizing the GaitRite system pre- and 3 weeks post-botulinum toxin injection along with measuring dystonia by the Fahn–Marsden Dystonia Scale (FMDS), pain by the Visual Analog Scale (VAS) and other lower limb functional outcomes such as gait velocity, the Berg Balance Scale (BBS), the Unified Parkinson’s Disease Rating Scale–Lower Limb Score (UPDRS–LL), the Timed Up and Go (TUG) test and the Goal Attainment Scale (GAS). We found that stride length increased significantly in both the affected (p = 0.02) and unaffected leg (p = 0.01) after treatment, and the improvement in stride length was roughly the same in each leg. Similar results were found for step length (p = 0.02) with improvement in the step length differential (p = 0.01). The improvements in the lower limb functional outcomes were also significant—FMDS, VAS, TUG, and UPDRS–LL decreased significantly after treatment (all p < 0.001), and BBS (p = 0.001), GAS (p < 0.001) except cadence (p = 0.37). BT injection improved walking in foot dystonia as evidenced through gait analysis, pain and lower limb functional outcomes. Main study limitations were small sample size and lack of control.

Efficacy and safety of botulinum toxin for treating motor dysfunction in patients with Parkinson’s disease: a systematic review and meta-analysis

“…Then, 22 studies were kept for further eligibility evaluation based on full texts. After excluding 10 studies according to the following reasons: ineligible patients (n=5), ineligible aims (n=2), ineligible language (n=1) and unrelated to our topic (n=2), a total of twelve studies were included,15–17 34–42 including six RCTs and six non-RCTs (all case series). A flowchart of the search process is shown in online supplemental figure 1.…”

“…Several studies have also evaluated the efficacy of BTX in improving drooling and sialorrhoea in PD patients, showing that BTX did not significantly improve the recovery or severity of drooling and sialorrhoea 11–14. In addition, studies evaluating the therapeutic efficacy of BTX on movement disorder in PD patients have reported ambiguous results 15–17…”

Intramuscular Injections and Dry Needling within Masticatory Muscles in Management of Myofascial Pain. Systematic Review of Clinical Trials

“…A PubMed database search using the term “Dantec Clavis” does reveal six results although none of the articles describes a case of TMD or myofascial pain treatment. However, the authors claim the use of Dantec Clavis for injecting the muscles, i.e., Wong et al reported injecting BTX into the muscles with the aid of Dantec Clavis in the management of sixth nerve palsies caused by nasopharyngeal carcinomas [ 60 , 61 , 62 , 63 ]. Nevertheless, EMG is a purely functional guidance, and therefore, it does not allow for morphologic tracking [ 36 ].…”

Use of Botulinum Neurotoxin in Parkinson’s Disease: A Critical Appraisal

“…In a further study on BoNT treatment in the specific muscles involved, a positive effect on pain and mobility was found in patients who had had deep brain stimulation (DBS) and developed foot dystonia [ 72 ]. The same group published results on improved walking in foot dystonia after BoNT injection [ 73 ].…”