Low-dose botulinum toxin with ankle taping for the treatment of spastic equinovarus foot after stroke

Objective: To evaluate the efficacy of a combined treatment for spastic foot using selective injections of botulinum toxin (BTA) into the tibialis posterior muscle followed by ankle taping, and to compare it with current BTA treatment procedure. Design: Single-blind randomized control trial. Three-month follow-up after treatment. Setting: Neurorehabilitation clinic. Subjects: Eighteen outpatients with equinovarus foot due to severe spasticity after stroke. Interventions: (1) Injection of 190 to 320 BTA U into several calf muscles (group A); (2) injection of 100 BTA U into the tibialis posterior muscle, followed by ankle-foot taping (group B). Main Outcome Measures: Ankle range of motion (ROM), Ashworth scale, gait velocity, and step length. Results: Average Ashworth scores decreased 1 point in both groups, but the benefit appeared of shorter duration in group B. Changes in both foot position at rest and passive ankle ROM were observed in all patients, without treatment-related differences, except for gain in passive dorsiflexion that appeared higher in group A. Gait velocity and step length showed similar increases in both groups. Conclusion: The combination of selective injections of low BTA doses with ankle-foot taping is as effective as the injection of the current desks for the reduction of foot inversion with positive effects on gait parameters. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.