Ask the Nurse: Botox Injections for Toe Walkers?
Answer: I have heard that Botox can help some special needs children in the area of “Toe-walking”. Is there any truth to this and if so, how? What might I expect?
Children who have idiopathic toe walking typically outgrow this condition. If there is a reduction in the child’s range of motion there are several options available. These may include:
- Wearing a brace or splint either during the day, night or both which limits the ability of the child to walk on his or her toes and stretches the Achilles tendon. An AFO is one type of brace.
- Serial casting where the foot is cast with the tendon stretched, and the cast is changed weekly with progressive stretching.
- Botox therapy can be used to paralyze the calf muscles to reduce the opposition of the muscles to stretching the Achilles stretching. This is usually used in conjunction with casting or splinting.
- If conservative measures fail to correct the toe walking after about 12–24 months, surgical lengthening of the tendon is an option.
Children who toe walk with more serious neuro-muscular conditions may need to seek additional specialists.
Botox as an option:
New research has found that Botox injections can alter gait patterns and, in some cases, eliminate idiopathic toe walking.
Published in the Journal of Children’s Orthopaedics, the study followed 15 children who received Botox injections in the calf muscles and underwent an exercise program to help reduce idiopathic toe walking. One year after treatment, 11 children remained in the study. Of those, three had stopped toe walking, four had decreased toe walking and four continued to toe walk, according to parents’ reports.
Gait analyses conducted over the course of the year found marked improvement in walking. Researchers concluded that Botox can improve gait, but does not guarantee a reduction in toe walking.
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This post originally appeared on our May/June 2012 Magazine