Surgical treatment versus botulinum toxin type 'a' injection for spastic equinus in cerebral palsy

Introduction: Cerebral palsy is the most common cause of childhood physical disability in developed countries. Equinus deformity is one of the most common deformities associated with cerebral palsy. Different methods of treatment of this deformity including repeated passive stretching manipulation and casting, surgical correction either by tendoachilis lengthening or gastrocnemius recession. Other modality of treatment includes Botulinum toxin 'A' injection in the affected muscle. The goal of this study was to compare the results of treatment of spastic equinus deformity in cerebral palsy by Botulinum toxin 'A' injection and surgical treatment. Materials and Methods: A prospective, randomized trial was performed to compare the results of surgical treatment of equinus in cerebral palsy versus botulinum toxin type 'A' injection. Fifty-five children with 70 feet suffering from cerebral palsy participated in this study in the period between October 2007 and March 2011. Children were divided randomly into two groups. Group 'A' included 25 children with spastic equnius (40 feet) treated surgically, while group 'B' included 30 children (30 feet) with Results: The improvement in group 'B' was better than group 'A'. The difference between them were significant as regard calf muscle tone grading, clonus, active range of ankle motion and highly significant in passive maximal dorsiflexion range. On the other hand, the difference was insignificant as regard ankle reflex grading. Conclusion: This study suggests that the usage of Botulinum toxin 'A' injection in treating spastic equinus deformity in cerebral palsy give superior results than the use of surgery. It is simpler, less invasive with better results of improvement.