Article

Hyperextension of the extensor hallucis longus (EHL) muscle is a
well recognised disabling sequel of either pyramidal or extrapyramidal lesions
causing what is known as striated or hitchhiker's toe. Surgery was the only
effective strategy to manage EHL hyperextension before botulinum toxin's use to
manage muscular dystonia and spasticity became widely popular. METHODS: A multicentre retrospective study. A standard proforma was sent to specialists in
neurological rehabilitation dealing routinely with this problem. The data was
analysed using descriptive statistics. RESULTS: Four consultants and two trainees
representing five separate neurological rehabilitation services agreed to
participate in the study. Full data was available from the 29 proformas
completed. The subjects were 15 females with an age range between 20 and 78 years
(mean 58.7). Stroke was the primary diagnosis in 18 subjects. Four subjects had
bilateral involvement. 16 subjects had either an associated foot drop or equino
varus deformity. Dysport(R) was used in 15 subjects with an average dose of 170
units per injection and Botox(R) in the other 14 with an average dose of 65
units. The treatment was effective in 24 subjects (83%). All patients receiving
Dysport(R) responded to the treatment. Whilst 5 Botox(R) treated patients failed
to respond to it (35% failure rate). Most of the non respondents seemed to
receive insufficient doses of Botox(R) (below 60 units). Surgical management was
successful in 3 out of the 5 non respondent cases. CONCLUSION: Botilinum Toxin is
an effective and safe method to manage hitchhicker's toe. In our study the
conversion ratio between Dysport(R) and Botox(R) was 2.5:1. Third of the patients
receiving Botox(R) failed to respond to the treatment most probably due to
insufficient doses used.

Langue : ANGLAIS