Botulinum toxin type-A in the management of spastic equinovarus deformity after stroke: Comparison of 2 injection techniques

OBJECTIVE: To retrospectively compare 2 injection techniques in the management of spastic equinovarus deformity after stroke. METHODS: Patients with stroke were seen at King Hussein Medical Center, Amman, Jordan between January and December 2009. The study design involved an open label retrospective analysis of medical records of 2 groups of comparable age and onset of first stroke. Botulinum toxin was injected into the calf muscles at 2 sites in group I (12 patients) and 4 sites in group II (14 patients). Functional gain was evaluated by the time to walk 10 meters at month one, 3, and 6 compared with baseline. RESULTS: There was significant improvement in walking time in each study group. However, there was no significant difference between the 2 groups as measured by the 10-meter walking time. CONCLUSION: Fewer injection sites would minimize patient discomfort and possibly the production of antibodies, yielding similar therapeutic effects.