Article

In children with cerebral palsy (CP), overactivity of the peroneus
longus (PL) muscle is a major contributor to pes planovalgus. This retrospective
study assessed whether abobotulinumtoxinA injections into a PL showing premature
activity on electromyography (EMG) clinically improved foot morphology in
children with CP. METHODS: Study participants were <6 years old, had a diagnosis
of CP, good functional abilities (Gross Motor Function Classification System
level 1 or 2), equinovalgus (initial contact with the hallux or head of the first
metatarsal) and overactive PL on EMG. The fore-, mid- and hindfoot were evaluated
clinically and radiologically before and after injection of abobotulinumtoxinA
(6-7 U/kg) into the PL. Radiological data were compared with reference values for
children without pes planovalgus. RESULTS: In total, 16 children (8 males; 10
hemiplegia, 6 diplegia; mean age: 3.2+/-1.5 years) received treatment. Mean
pre-and post-treatment angles in clinical assessment of dorsiflexion of the
talocrural articulation did not differ with both knees flexed (24.4+/-7.5 vs.
22.2+/-8.0 degrees; P=0.19) or extended (17.2+/-8.0 vs. 16.6+/-6.8 degrees;
P=0.36). Radiographic data pre-treatment versus reference data revealed forefoot
pronation (metatarsal stacking angle 2.1+/-8.3 vs. 8.0+/-2.9 degrees; P=0.002),
midfoot planus (lateral talo-first metatarsal 28.5+/-15.0 vs. 13.0+/-7.5 degrees;
P<0.001; talocalcaneal angle 54.6+/-8.6 vs. 49.0+/-6.9 degrees; P=0.004) and
significantly decreased calcaneus dorsiflexion, without hindfoot equinus
(calcaneal pitch angle 7.9+/-6.0 vs. 17.0+/-6.0 degrees; P<0.001). After
treatment, the metatarsal stacking angle did not differ from reference values
(P=0.15). As compared with before treatment, treatment improved mean angles for
metatarsal stacking (2.1+/-8.3 vs. 7.1+/-3.9 degrees, respectively, P=0.002),
lateral talo-first metatarsal and talocalcaneal (both P<0.001), with no change in
the hindfoot. CONCLUSION: PL may be an early target for abobotulinumtoxinA
treatment in pes planovalgus associated with premature PL activity in children
with CP.
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