Selective botulinum toxin injection in the treatment of recurrent deformity following surgical correction of club foot. A preliminary report of 3 children

• Published in: Acta orthopaedica Scandinavica Vol. 75; no. 5; pp. 630 - 633
• Main Authors: MITCHELL, Piers D, TISDALL, Martin, ZADEH, Hamid G
• Format: Journal Article
• Language: English
• Published: Basingstoke Taylor & Francis 01.10.2004
• Subjects: Biological and medical sciences; Botulinum Toxins, Type A - administration & dosage; Casts, Surgical; Clubfoot - drug therapy; Clubfoot - surgery; Diseases of the osteoarticular system; Humans; Infant; Injections, Intramuscular; Medical sciences; Recurrence; Human; High risk; Reoperation; Relapse; Enzyme; Report; Orthopedic treatment; Diseases of the osteoarticular system; Metalloendopeptidases; Injection; Recurrent; Clubfoot; Peptidases; Bontoxilysin; Clinical management; Revision; Malformation; Surgery; Hydrolases; Complication; Soft tissue; Child; Corrections; Release
• ISSN: 0001-6470
• DOI: 10.1080/00016470410001538

Management of a child with club foot deformity that recurs after an apparently successful posteromedial soft tissue release remains a challenge. Revision surgery is often attempted, but this carries a high risk of significant scarring or neurovascular complications. We have treated 3 children (3 feet) with relapsed club foot and fixed deformities, using Botulinum toxin A (BTX-A) injection into muscle groups clinically thought to be responsible for recurrent deformity, followed by moulded plaster casts. Two cases have maintained a good foot position with an minimum follow-up of 18 months, and one other is also doing well having had a tibialis anterior tendon transfer as well as the BTX-A therapy. In our limited experience, targeted BTX-A injection with plaster casting has been safe, and may obviate the need for major revision surgery in a proportion of cases with recurrent club foot deformity following previous posteromedial soft tissue release.