Foot: Original ArticleTreatment of Idiopathic Clubfoot Utilizing Botulinum A Toxin: A New Method and its Short-term OutcomesAlvarez, Christine M MD, FRCSC, MSc (Surg)*; Tredwell, Stephen J MD, FRCSC*; Keenan, Sean P MD, FRCPC, MSc (Epid)†; Beauchamp, Richard D MD, FRCSC*; Choit, Rachel L BSc*; Sawatzky, Bonita J PhD*; De Vera, Mary A BSc*Author Information From *University of British Columbia, Faculty of Medicine, Division of Pediatric Orthopaedics, Department of Orthopaedics, Children's and Women's Hospital of British Columbia, Vancouver, BC, Canada; and †University of British Columbia, Faculty of Medicine, Division of Critical Care, Department of Medicine, Royal Columbian Hospital, New Westminster, BC, Canada. Study conducted at Children's and Women's Hospital of British Columbia, Vancouver, Canada. None of the authors received financial support for this study. Reprints: Dr. Christine M. Alvarez, Department of Orthopaedics, British Columbia's Children's Hospital A203, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4 (e-mail: email@example.com). Journal of Pediatric Orthopaedics: March-April 2005 - Volume 25 - Issue 2 - p 229-235 doi: 10.1097/01.bpo.0000149861.50400.db Buy Metrics Abstract A pivotal point in most clubfoot management protocols is Achilles tendon lengthening or tenotomy to address hindfoot deformity. The effectiveness of botulinum A toxin (BTX-A) in attenuating the function of the triceps surae muscle complex as an alternative to tenotomy was investigated. Fifty-one patients with 73 idiopathic clubfeet were recruited. Outcome measures included surgical rate, Pirani clubfoot score, ankle dorsiflexion with knee in flexion and extension, and recurrences. Patients were divided according to age: group 1 (<30 days old) and group 2 (>30 days and <8 months old). Ankle dorsiflexion in knee flexion and extension remained above 20 degrees and 15 degrees, respectively, and Pirani scores below 0.5 following BTX-A injection for both groups. One of the 51 patients required limited posterior release and 9 patients required repeat manipulation and casting plus or minus BTX-A injection. The use of BTX-A as an adjunctive therapy in the noninvasive approach of manipulation and casting in idiopathic clubfoot is a safe and effective treatment. © 2005 Lippincott Williams & Wilkins, Inc.