[Efficacy of botulinum toxin in the treatment of dynamic equinus and equinovarus foot deformities in children with hemiplegic cerebral palsy].

The objective of the study was to assess factors modulating the efficacy of botulinum toxin injections in the correction of dynamic equinus and equinovarus foot deformities in children with hemiplegic cerebral palsy. The efficacy of treatment was evaluated in 40 children. Clinical data including spasticity assessment by the original Ashworth scale, postural and gate changes were collected. Spasticity grade 4-5 by the Ashworth scale and retraction 90-120 degrees reduce the likelihood of successful correction of equinus contracture. Botulinum injections can be used as basic therapy. In cases of transient contracture more than 120 degrees, combined methods of treatment are recommended. The hindfoot varus less 30 degrees, which can be passively corrected before treatment and in the presence of the positive Coleman block test, more likely needs injection in triceps muscle for correction. If the hindfoot varus is more than 30 degrees and the Coleman block test is negative, the combined treatment is necessary.