A single-blinded, randomized pilot study of botulinum toxin type a combined with non-pharmacological treatment for spastic foot

Objective: To explore the effect of treatment after botulinum toxin type A combined with treatments for the spastic foot. Design: Single-blind, randomized trial, with 3-month follow-up. Subjects: Twenty-three chronic hemiplegic adult patients with spastic equinus foot. Methods: Following botulinum toxin type A injection at the medial and lateral gastrocnemius, patients were assigned randomly to 3 groups, and treated with taping, electrical stimulation or stretching. They were evaluated before treatment (t0), and at 10 (t1), 20 (t2) and 90 (t3) days after treatment. Outcome measures were: Modified Ashworth Scale; passive range of motion at the ankle; measurement of muscle action potential at the gastrocnemius medialis; and measurement of maximum ankle dorsillexion angle in stance using gait analysis. Results: The group treated with electrical stimulation performed better at t1 on the Modified Ashworth Scale. The taping and electrical stimulation groups performed better in all outcome measures at t3. The taping group performed better mainly for maximum ankle dorsiflexion angle in stance. The stretching group showed a less durable result, with some worsening at the t3 evaluation compared with the assessment performed before treatment. Conclusions: This pilot study indicates that combining botulinum toxin type A administration for the ankle plantar flexors with taping and electrical stimulation might be beneficial.