Equinovarus foot deformity

Botulinum toxin type A

The use of botulinum toxin type A instead of Achilles lengthening has been studied and has been shown to work. However, it is not widely accepted.[45]Alvarez CM, De Vera MA, Chhina H, et al. The use of botulinum type A toxin in the treatment of idiopathic clubfoot: 5-year follow-up. Pediatr Orthop. 2009;29:570-575. http://www.ncbi.nlm.nih.gov/pubmed/19700985?tool=bestpractice.com [46]Cummings RJ. The effectiveness of botulinum A toxin as an adjunct to the treatment of clubfeet by the Ponseti method: a randomized, double blind, placebo controlled study. J Pediatr Orthop. 2009;29:564-569. http://www.ncbi.nlm.nih.gov/pubmed/19700984?tool=bestpractice.com ​ One randomised controlled trial published in 2018 showed no difference in outcomes between botulinum toxin type A and placebo in clubfeet treated with the Ponseti method of manipulation and casting.[47]Alvarez CM, Wright JG, Chhina H, et al. Botulinum toxin type A versus placebo for idiopathic clubfoot: a two-center, double-blind, randomized controlled trial. J Bone Joint Surg Am. 2018 Sep 19;100(18):1589-96. http://www.ncbi.nlm.nih.gov/pubmed/30234623?tool=bestpractice.com ​ Botulinum toxin type A appears to be safe for use in children under 2 years of age with clubfoot.[48]Chhina H, Howren A, Simmonds A, et al. Onabotulinumtoxin A injections: a safety review of children with clubfoot under 2 years of age at BC Children's Hospital. Eur J Paediatr Neurol. 2014 Mar;18(2):171-5. https://www.doi.org/10.1016/j.ejpn.2013.11.002 http://www.ncbi.nlm.nih.gov/pubmed/24268889?tool=bestpractice.com