Botulinum Toxin on Children with Equinus Foot

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Spastic Cerebral Palsy (CP) is a complex pathology of neurologic origin expressed by physical disabilities due to tone alterations of muscles. The equinus foot is a pathological condition that is commonly observed in children with CP. Such condition is characterized by a permanent plantar flexion that leads to toe walking and balancing issues. The causes were identified in the status of permanent contraction or spasticity of the Triceps surae muscles. Several treatments were proposed in the literature. These can be reversible, e.g. braces, physical therapy, stretching, strengthening of the dorsiflexors and botulinum toxin injections (BTX-A) or non-reversible, e.g. surgical lengthening of the triceps surae and Single Event Multi Level Surgery (SEMLS). Choosing the correct or optimal treatment or each patient is not an easy task, as the success and durability of the treatment ultimately depends on patient’s age, conditions, severity of the illness and gait abnormalities. Nowadays the walking abnormalities can be assessed by a set of quantitative measurements that provide an objective description of the condition of the patient as well as the effects of the treatment. Several studies were conducted on the various treatment options. Computerized gait and its classification by means of synthetic descriptors already demonstrated that SEMLS produces a long term and stable improvement.