Equinovarus foot deformity

OnabotulinumtoxinA

The use of onabotulinumtoxinA (formerly known as botulinum toxin type A) instead of Achilles lengthening has been studied and has been shown to work. However, it is not widely accepted.[45]Alvarez CM, De Vera MA, Chhina H, et al. The use of botulinum type A toxin in the treatment of idiopathic clubfoot: 5-year follow-up. Pediatr Orthop. 2009;29:570-575. http://www.ncbi.nlm.nih.gov/pubmed/19700985?tool=bestpractice.com [46]Cummings RJ. The effectiveness of botulinum A toxin as an adjunct to the treatment of clubfeet by the Ponseti method: a randomized, double blind, placebo controlled study. J Pediatr Orthop. 2009;29:564-569. http://www.ncbi.nlm.nih.gov/pubmed/19700984?tool=bestpractice.com ​ One randomized controlled trial published in 2018 showed no difference in outcomes between onabotulinumtoxinA and placebo in clubfeet treated with the Ponseti method of manipulation and casting.[47]Alvarez CM, Wright JG, Chhina H, et al. Botulinum toxin type A versus placebo for idiopathic clubfoot: a two-center, double-blind, randomized controlled trial. J Bone Joint Surg Am. 2018 Sep 19;100(18):1589-96. http://www.ncbi.nlm.nih.gov/pubmed/30234623?tool=bestpractice.com ​ Onabotulinumtoxin A appears to be safe for use in children under 2 years of age with clubfoot.[48]Chhina H, Howren A, Simmonds A, et al. Onabotulinumtoxin A injections: a safety review of children with clubfoot under 2 years of age at BC Children's Hospital. Eur J Paediatr Neurol. 2014 Mar;18(2):171-5. https://www.doi.org/10.1016/j.ejpn.2013.11.002 http://www.ncbi.nlm.nih.gov/pubmed/24268889?tool=bestpractice.com