Improved Gait and Radiological Measurements After injection of Botulinum Toxin Into Peroneus Longus in Young Children With USCP and Equinovalgus Gait

Children with cerebral palsy develop foot deformities due to a combination of factors including muscle shortening, hypertonia, weakness, and cocontraction of muscles acting at the ankle joint resulting in an altered gait pattern. We hypothesized these factors affect the peroneus longus (PL) and tibi...

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Veröffentlicht in:Pediatric neurology 2023-05, Vol.142, p.1-9
Hauptverfasser: Boulay, Christophe, Sangeux, Morgan, Authier, Guillaume, Jacquemier, Michel, Merlo, Andrea, Chabrol, Brigitte, Jouve, Jean-Luc, Gracies, Jean-Michel, Pesenti, Sébastien
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container_title Pediatric neurology
container_volume 142
creator Boulay, Christophe
Sangeux, Morgan
Authier, Guillaume
Jacquemier, Michel
Merlo, Andrea
Chabrol, Brigitte
Jouve, Jean-Luc
Gracies, Jean-Michel
Pesenti, Sébastien
description Children with cerebral palsy develop foot deformities due to a combination of factors including muscle shortening, hypertonia, weakness, and cocontraction of muscles acting at the ankle joint resulting in an altered gait pattern. We hypothesized these factors affect the peroneus longus (PL) and tibialis anterior (TA) muscles couple in children who develop equinovalgus gait first followed by planovalgus foot deformities. Our aim was to evaluate the effects of abobotulinum toxin A injection to the PL muscle, in a cohort of children with unilateral spastic cerebral palsy and equinovalgus gait. This was a prospective cohort study. The children were examined within 12 months before and after injection to their PL muscle. Twenty-five children of mean age 3.4 (S.D.: 1.1) years were recruited. We found significant improvement in foot radiology measures. Passive extensibility of the triceps surae did not change, whereas active dorsiflexion increased significantly. Nondimensional walking speed increased by 0.1 (95% confidence interval [CI], [0.07, 0.16]; P < 0.001), and the Edinburgh visual gait score improved by 2.8 (95% CI, [-4.06, -1.46]; P < 0.001). Electromyography showed increased recruitment for gastrocnemius medialis (GM) and TA but not for PL during the reference exercises (standing on tip toes for GM/PL, active dorsiflexion for TA) and decreased activation percentages for PL/GM and TA across sub-phases of gait. One key advantage of treating the PL muscle only might be to address foot deformities without interfering with the main plantar flexors that are instrumental to support body weight during gait.
doi_str_mv 10.1016/j.pediatrneurol.2023.01.019
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Electromyography showed increased recruitment for gastrocnemius medialis (GM) and TA but not for PL during the reference exercises (standing on tip toes for GM/PL, active dorsiflexion for TA) and decreased activation percentages for PL/GM and TA across sub-phases of gait. 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Electromyography showed increased recruitment for gastrocnemius medialis (GM) and TA but not for PL during the reference exercises (standing on tip toes for GM/PL, active dorsiflexion for TA) and decreased activation percentages for PL/GM and TA across sub-phases of gait. 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subjects Abobotulinum toxin A
Cerebral Palsy - complications
Cerebral Palsy - diagnostic imaging
Cerebral Palsy - drug therapy
Child
Child, Preschool
Children with cerebral palsy
Electromyography
Equinovalgus
Foot Deformities
Gait - physiology
Humans
Life Sciences
Muscle, Skeletal - diagnostic imaging
Peroneus longus
Prospective Studies
Radiology
title Improved Gait and Radiological Measurements After injection of Botulinum Toxin Into Peroneus Longus in Young Children With USCP and Equinovalgus Gait
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