A Pilot Study of Delayed Versus Immediate Serial Casting After Botulinum Toxin Injection for Partially Reducible Spastic Equinus

Abstract

There is a clear benefit in delaying serial casting after the injection of botulinum toxin in the recurrence of spasticity at the gastrosoleus that may also offer an advantage regarding the incidence of painful episodes associated with casting. Most importantly, reducing the recurrence of spasticity by delayed serial casting may offer the possibility of decreasing the frequency of botulinum toxin reinjections.

The Effect and Complication of Botulinum Toxin Type A Injection with Serial Casting for the Treatment of Spastic Equinus Foot

“…Results showed greater improvement in the ankle joint angle, and greater reduction in spasticity in the injection with casting group, which is consistent with studies conducted earlier 10,15-17…”

“…Newman et al17 compared 2 groups: 1) the first group received serial casting immediately after injection, 2) the second group received casting 4 weeks after injection. Six months later, the ankle angle in the second group improved significantly and none of the patients in the group expressed pain, whereas children in the first group expressed pain.…”

“…Short leg casts are used to treat eqinus foot deformity by maintaining a long-term tonic stretch in muscles to increase elasticity in muscle-ligaments parts, and to increase the number of sarcolemma in muscle fibers 5. Various studies regarding the use of BTX-A injection followed by serial casting for treatment of spastic equinus foot have been published abroad 6-17. However, casting after injection is not yet widely used in Korea, therefore further studies on clinical outcomes and side effects are needed.…”

A Critical Evaluation of the Updated Evidence for Casting for Equinus Deformity in Children with Cerebral Palsy

“…The five studies investigated the effect of casting alone (McNee et al, ), compared BoNT alone with combined BoNT and casting regimes (Hayek et al, ; Park et al, ; Lee et al, ) or investigated immediate versus delayed casting post‐BoNT injection (Newman et al, ). Different casting regimes and inclusion criteria were reported.…”

“…Hayek et al () also report equivocal gains in both groups for gait speed and step length, although they note a more consistent response profile for observational gait scale scores in those receiving casting post‐BoNT. Although observational gait scale scores suggested a trend to greater and more sustained improvement with delayed casting, compared with immediate casting post‐BoNT, between‐group differences did not reach significance at any time point (Newman et al, ).…”