Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: Clinical and radiological evaluations in young children

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Abstract

Background: In children with cerebral palsy (CP), overactivity of the peroneus longus (PL) muscle is a major contributor to pes planovalgus. This retrospective study assessed whether abobotulinumtoxinA injections into a PL showing premature activity on electromyography (EMG) clinically improved foot morphology in children with CP. Methods: Study participants were <. 6 years old, had a diagnosis of CP, good functional abilities (Gross Motor Function Classification System level 1 or 2), equinovalgus (initial contact with the hallux or head of the first metatarsal) and overactive PL on EMG. The fore-, mid- and hindfoot were evaluated clinically and radiologically before and after injection of abobotulinumtoxinA (6-7 U/kg) into the PL. Radiological data were compared with reference values for children without pes planovalgus. Results: In total, 16 children (8 males; 10 hemiplegia, 6 diplegia; mean age: 3.2. ±. 1.5 years) received treatment. Mean pre-and post-treatment angles in clinical assessment of dorsiflexion of the talocrural articulation did not differ with both knees flexed (24.4. ±. 7.5 vs. 22.2. ±. 8.0 degrees; P=. 0.19) or extended (17.2. ±. 8.0 vs. 16.6. ±. 6.8 degrees; P=. 0.36). Radiographic data pre-treatment versus reference data revealed forefoot pronation (metatarsal stacking angle 2.1. ±. 8.3 vs. 8.0. ±. 2.9 degrees; P=. 0.002), midfoot planus (lateral talo-first metatarsal 28.5. ±. 15.0 vs. 13.0. ±. 7.5 degrees; P<. 0.001; talocalcaneal angle 54.6. ±. 8.6 vs. 49.0. ±. 6.9 degrees; P=. 0.004) and significantly decreased calcaneus dorsiflexion, without hindfoot equinus (calcaneal pitch angle 7.9. ±. 6.0 vs. 17.0. ±. 6.0 degrees; P<. 0.001). After treatment, the metatarsal stacking angle did not differ from reference values (. P=. 0.15). As compared with before treatment, treatment improved mean angles for metatarsal stacking (2.1. ±. 8.3 vs. 7.1. ±. 3.9 degrees, respectively, P=. 0.002), lateral talo-first metatarsal and talocalcaneal (both P<. 0.001), with no change in the hindfoot. Conclusion: PL may be an early target for abobotulinumtoxinA treatment in pes planovalgus associated with premature PL activity in children with CP.

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Boulay, C., Jacquemier, M., Castanier, E., Giorgi, H., Authier, G., Pomero, V., … Viehweger, E. (2015). Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: Clinical and radiological evaluations in young children. Annals of Physical and Rehabilitation Medicine, 58(6), 316–321. https://doi.org/10.1016/j.rehab.2015.09.001

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