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Updated: May 11, 2026

Bilateral Assessment of the Corticospinal Pathways of the Ankle Muscles Using Navigated Transcranial Magnetic Stimulation
Published on: February 19, 2019
Botulinum toxin in gait dysfunction due to ankle clonus: a case series
Siobhan McGuinness1, Josephine Hillan, Sheena B Caldwell
1Regional Acquired Brain Injury Unit, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK. siobhana.mcguinness@belfasttrust.hscni.net
Objectives:
Our purpose is to assess the effectiveness of Botulinum toxin (Btx) on gait dysfunction due to ankle clonus in neurological patients.
Methods:
We use a retrospective case note review of 11 patients attending the Regional Acquired Brain Injury Unit (RABIU), Musgrave Park Hospital, Belfast, Northern Ireland. All patients had received Btx for the treatment of ankle clonus. Demographic data including diagnosis and time since neurological insult was collected. Information regarding walking speed and assistance required to walk before and after Btx treatment was analysed.
Results:
In 10 of 11 patients, walking speed was significantly improved at 4-6 weeks post Btx injections (P = 0.006) and at 14-16 weeks post Btx injections (P = 0.005). Eight patients reduced their level of dependency on assistance. Subjective improvements in levels of pain, gait pattern and 'toe clawing' were also reported.
Conclusions:
Our findings suggest that Botulinum toxin has a role in treating ankle clonus in neurological patients, where it interferes in gait. Walking speed and level of dependence on others improved in this group.
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