Evaluation of the results of botulinum toxin typeA for the treatment of the spastic equinus feet in cerebral palsy among children over two years of age.

Dr Hanene BELABBASSIa, Dr Fella Badiaa AIDJAa, Dr Redha ALLOUTIa, Prof Houria KACEDa

a CHU Djillali Bounaama, Douéra

Background: Botulinum toxin type A (BTA) belongs to a therapeutic arsenal of the spastic equinus feet (SEF) in cerebral palsy (CP) and in association with splints posture, walking orthoses and kinesitherapy.

Aim: To evaluate the results of BTA on SEF in CP using modified Ashworth scale (MAS) and the Silfverskiold test (ST) among children over 2 years old.

Patients and methods: It’s a retrospective, descriptive study, performed from January 2013 to January 2014 at the PMR department of Douera’s hospital university.

We’ve included children with SEF who’ve never been treated before.

We’ve excluded children who’ve been injected with BTA in muscle groups other than the Triceps surae.

The protocol consisted of BTA injections, followed by the rehabilitation program a month later.

Assessments were done using MAS and ST before and after the total injections.

Results: Twenty-one children were examined (13 girls and 8 boys; mean ages of 7. 5±3. 58 years).

SEF was static in 19% and dynamic in 38.1% of cases. It was static and dynamic in the remaining 42.9%.

The soleus was injected in 9.5% of cases, gastrocnemius in 19% of cases and triceps surae in 71.4%. The average number of injections was 2.90±1.18.

Improvement was observed in both MAS and ST comparing before and after treatments by BTA. These results are statistically significant with p value of <0.0001 (mean of Ashworth scale2.76±0.54 vs 1.33±0.57).

Discussion-conclusion: There was a decrease in triceps surae spasticity and stabilization or improvement of tarsal ankle angle. These measures only evaluate one aspect of SEF.


  1. V-Seetha, Assessement of the treatment of spastic equinus foot by botulinum toxin type A, centred’Annecy, Human health and pathology 2008.
  2. J-Luauté et al. Traitment of focal limb spasticity with botulinum toxin after stroke. Annales de Réadaptation et de Médecine Physique 47 (2004) 555-562.

Keywords : spastic equinus feet, Botulinum toxin type A, cerebral palsy, modified Ashworth scale, Silfverskiold test