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Botulinum toxin A does not improve cast treatment for idiopathic toe-walking - a randomized controlled trial
Karolinska Institutet, Dept. of Women's and Children's Health.
Karolinska Institutet, Dept. of Women's and Child's Health.
Karolinska Institutet, Dept. of Women's and Children's Health.
Karolinska Institutet, Dept. of Women's and Children's Health.
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2013 (English)In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 95, no 5, p. 400-407Article in journal (Refereed) Published
Abstract [en]

Background: There are many treatments for idiopathic toe-walking, including casts with or without injection of botulinum toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toewalking by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting neuropsychiatric problems. Methods: All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study. Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking. Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children were evaluated with a screening questionnaire for neuropsychiatric problems. Results: No differences were found in any outcome parameter between the groups before treatment or at three or twelve months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were improved at both three and twelve months in both groups, even though many children still demonstrated some degree of toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems. Conclusion: Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the outcome of cast-only treatment. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Place, publisher, year, edition, pages
2013. Vol. 95, no 5, p. 400-407
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Orthopaedics
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URN: urn:nbn:se:kth:diva-103881DOI: 10.2106/JBJS.L.00889ISI: 000334971200003Scopus ID: 2-s2.0-84876423120OAI: oai:DiVA.org:kth-103881DiVA, id: diva2:562148
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QC 20150225

Available from: 2012-10-23 Created: 2012-10-23 Last updated: 2018-01-12Bibliographically approved

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Gutierrez-Farewik, Elena

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