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IncobotulinumtoxinA Injection for Treating Children with Idiopathic Toe Walking: A Retrospective Efficacy and Safety
Mirko Filippetti1, Alessandro Picelli1,2, Rita Di Censo1
1Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy.
Insights
IncobotulinumtoxinA injections improved ankle dorsiflexion in children with idiopathic toe walking (ITW). This safe treatment showed a lasting effect, suggesting potential for ITW management.
Area of Science:
- Neurology
- Orthopedics
- Pediatrics
Background:
- Idiopathic toe walking (ITW) lacks a definitive treatment.
- Botulinum neurotoxin-A injections have shown promise for ITW.
Purpose of the Study:
- To evaluate the efficacy and safety of incobotulinumtoxinA in treating idiopathic toe walking.
- To assess the duration of the treatment's effect on ankle dorsiflexion.
Main Methods:
- Retrospective analysis of 28 children with ITW treated with incobotulinumtoxinA.
- Measurements of maximal passive ankle dorsiflexion before, during, and after treatment.
- Assessment of adverse effects.
Main Results:
- IncobotulinumtoxinA significantly improved maximal passive ankle dorsiflexion.
- The positive effect of the injection lasted up to 6 months in some patients.
- No adverse effects were reported.
Conclusions:
- IncobotulinumtoxinA is a safe and effective treatment for improving ankle dorsiflexion in ITW.
- The treatment's effects may be longer-lasting in ITW compared to cerebral palsy.
- Further research, including randomized controlled trials and combination therapies, is warranted.
Abstract:
There is no gold-standard treatment for idiopathic toe walking (ITW). Some previous evidence suggested that botulinum neurotoxin-A injection might improve ITW. This is a single-center retrospective study on children with ITW treated with incobotulinumtoxinA injection in the gastrocnemius medialis/lateralis muscles. We screened the charts of 97 ITW children treated with incobotulinumtoxinA (January 2019-December 2021), and the data of 28 of them, who satisfied the inclusion/exclusion criteria, were analyzed. The maximal passive ankle dorsiflexion (knee extended) was assessed at three time points, i.e., immediately before incobotulinumtoxinA injection (T0), after incobotulinumtoxinA injection during the timeframe of its effect (T1), and at follow-up, when the effect was expected to disappear (T2). The maximal passive ankle dorsiflexion was improved by incobotulinumtoxinA injection, and the effect lasted up to 6 months in some children. No adverse effects were reported to incobotulinumtoxinA injections. The treatment with incobotulinumtoxinA might improve the maximal passive ankle dorsiflexion and is safe and well-tolerated in ITW with a longer-than-expected effect in comparison to cerebral palsy. These results may offer ground to future randomized controlled trials and studies assessing the effect of BoNT-A in combination with other non-invasive approaches and exercise programs in children with ITW.
