Botulinum toxin type A and casting versus botulinum toxin type A or casting in treating equinus gait of children with cerebral palsy

Kelly, Barbara; MacKay-Lyons, Marilyn; Ruggles, Tim; Woodward, Judie

doi:10.1002/14651858.cd007343.pub2

Cited by 1 publication

(2 citation statements)

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“…Therefore, the required muscle force would be reduced, supporting the notion that equinus gait would serve as a compensatory strategy to accommodate plantarflexor weakness (Hampton et al, 2003). Many clinical interventions for children with CP aim to improve walking pattern by altering the ankle joint range of motion or lengthening the external moment arm along the foot (Firth et al, 2013;Chung et al, 2015;MacKay-Lyons et al, 2017;Multani et al, 2019). Both would impact the effective mechanical advantage of the plantarflexors, yet little is known about the impact on muscle function.…”

Section: Discussionmentioning

confidence: 94%

“…To treat lever arm dysfunction, surgical (Firth et al, 2013;Chung et al, 2015) or therapeutic interventions such as Botulinum toxin-A injections or serial casting (MacKay-Lyons et al, 2017;Multani et al, 2019) are used. Such interventions alter the effective mechanical advantage of the plantarflexors and consequently, the muscle force requirements.…”

Section: Introductionmentioning

confidence: 99%

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Effective Mechanical Advantage About the Ankle Joint and the Effect of Achilles Tendon Curvature During Toe-Walking

et al. 2020

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Aim: To study the causes of locomotor dysfunction, estimate muscle forces, or understand the influence of altered sarcomere and muscle properties and behaviours on whole body function, it is necessary to examine the leverage with which contractile forces operate. At the ankle joint, current methods to quantify this leverage for the plantarflexors do not account for curvature of the Achilles tendon, and so may not be appropriate when studying equinus gait. Thus, novel methodologies need to be developed and implemented to quantify the Achilles tendon moment arm length during locomotion.Methods: Plantarflexor internal moment arm length and effective mechanical advantage of 11 typically developed young adults were calculated throughout stance, while heeltoe walking and voluntarily toe-walking on an instrumented treadmill. Achilles tendon moment arm was defined in two-ways: (1) assuming a straight tendon, defined between the gastrocnemius medialis myotendinous junction and Achilles tendon insertion point, and (2) accounting for tendon curvature, by tracking the initial path of the Achilles tendon from the calcaneal insertion.Results: When accounting for tendon curvature, Achilles tendon moment arm length and plantarflexor effective mechanical advantage did not differ between walking conditions (p > 0.05). In contrast, when assuming a straight tendon, Achilles tendon moment arm length (p = 0.043) and plantarflexor effective mechanical advantage (p = 0.007) were significantly greater when voluntary toe-walking than heel-toe walking in late stance.Discussion: Assuming a straight Achilles tendon led to a greater Achilles tendon moment arm length and plantarflexor effective mechanical advantage during late stance, compared to accounting for tendon curvature. Consequently, plantarflexor muscle force would appear smaller when assuming a straight tendon. This could lead to erroneous interpretations of muscular function and fascicle force-length-velocity behaviour in vivo, and potentially inappropriate and ineffective clinical interventions for equinus gait.

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