Botulinum Toxin A Does Not Improve the Results of Cast Treatment for Idiopathic Toe-Walking

Abstract

Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the outcome of cast-only treatment.

Treatment for idiopathic toe walking: A systematic review of the literature

“…Table I shows the methodological characteristics of the 19 studies included in the review. Most studies used a within-group design with pre-post treatment comparisons and were classified as RCT (n = 1) (22), case series (n = 8) (14,17,18,(23)(24)(25)(26)(27), qualitative study (n = 1) (28), cross-sectional study (n = 1) (29), historically controlled study (n = 1) (30), or cohort studies (n = 7) (15, 16, 31-33, 34, 35). only 9 studies used a prospective study design, whereas 10 studies were conducted retrospectively.…”

“…only 9 studies used a prospective study design, whereas 10 studies were conducted retrospectively. only one study randomly assigned treatments to the participants (22). Two studies incorporated a non-treatment group (16,32), whereas 2 other studies used a group of children with cerebral palsy for comparison (31,35).…”

“…In only one of these studies, the historical data were used for quantitative comparisons (30). one study was scored as ocEBM level 1 (22), all other studies were scored as level 4. The MInoRS scores of the latter studies ranged from 2 to 18, emphasizing the methodological heterogeneity amongst the observational designs.…”

“…however, the operationalization of the concept "diagnosis of exclusion" differed substantially between the studies. In 1 study the concept was not specified at all (28), in the other 18 studies at least neurological deficits were ruled out, either by history-taking (15,17,24,25), 5 studies excluded psychological or behavioural problems (15,18,23,25,32), and 8 studies excluded orthopaedic problems other than equinus deformity of the ankle (14,15,18,22,23,29,31,34). The inclusion criteria in 10 studies were dominated by their retro spective nature.…”

“…The effectiveness of PT (motor control intervention) was examined in one study (17), serial casting in 3 (15,23,31), BTX-A in 4 (24,26,27,33), and surgery in 5 studies (14,28,30,34,35). Six studies (1 RCT and 5 non-randomized, uncontrolled studies) compared the effects of different interventions (16,18,22,25,29,32). criteria for the use of a particular type of intervention, however, were not provided.…”