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A Novel Ultrasound Window for Simultaneous Botulinum Neurotoxin Injection Into Three Deep Leg Muscles in Ankle and

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Summary

This study introduces a new ultrasound technique for botulinum neurotoxin (BoNT) injections. It allows simultaneous treatment of three deep posterior leg muscles, improving efficiency and patient comfort for spasticity.

Keywords:
botulinum toxinsinterventionallower extremitymuscle spasticityultrasonography

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Area of Science:

  • Neurology
  • Musculoskeletal Medicine
  • Medical Imaging

Background:

  • Ankle and foot conditions with muscle overactivity often necessitate botulinum neurotoxin (BoNT) injections.
  • Traditional injection methods for flexor digitorum longus (FDL), tibialis posterior (TP), and flexor hallucis longus (FHL) muscles can be time-consuming and may require multiple punctures.
  • Improving procedural efficiency and patient comfort is crucial in managing lower limb spasticity.

Purpose of the Study:

  • To introduce and evaluate a novel ultrasound (US) window for simultaneous BoNT injections into the FDL, TP, and FHL muscles.
  • To enhance efficiency and patient comfort in treating ankle and foot spasticity using a new posterior approach.

Main Methods:

  • Development of a novel posterior approach utilizing a transverse US probe placement on the distal leg.
  • Modification of traditional probe handling to achieve simultaneous visualization of TP, FDL, and FHL within a single US window.
  • Performance of a single skin puncture three-muscle in-plane injection technique.

Main Results:

  • The novel US window facilitates concurrent visualization of the TP, FDL, and FHL muscles.
  • This technique allows for simultaneous, in-plane, three-muscle injections with a single skin puncture.
  • Potential for more precise needle and injectate placement, improved procedural efficiency, and enhanced patient comfort.

Conclusions:

  • The developed ultrasound technique offers a practical and efficient method for simultaneous BoNT injections into deep posterior leg muscles.
  • This approach may significantly improve procedural efficiency and patient comfort compared to traditional methods.
  • The technique is a viable option for routine clinical use in managing ankle and foot muscle overactivity and spasticity.