Casting, taping or stretching after botulinum toxin type A for spastic equinus foot: a single-blind randomized trial on adult stroke patients

Objective: To investigate the effect of different adjunctive treatments after botulinum toxin type A. Design: Single-blind, randomized trial, with three-month follow-up. Setting: Secondary rehabilitative care. Subjects: Convenience sample of 69 chronic hemiplegic adult patients with spastic equinus foot. Interventions: Following botulinum toxin type A injection at the plantar flexors, patients were randomly assigned to three groups and treated with either taping, casting or stretching for one week, and with stretching and gait training for the next week. Outcome measures: Modified Ashworth Scale at plantar flexors, passive range of motion at the ankle, six-minute walking test, 10-metre walking test, Functional Ambulation Categories, ankle dorsiflexor strength were evaluated before treatment (t(0)) at 20 days (t(1)) and 90 days (t(2)) after treatment. Results: At t(1) only the taping and casting groups showed significant improvements in Modified Ashworth Scale, six-minute walking test, 10-metre walking test and passive range of motion (P < 0.02). At t(2), while the results were maintained in the casting group, only six-minute walking test and Modified Ashworth Scale were still significantly improved in the taping group. Ankle dorsiflexor strength and Functional Ambulation Categories did not change in any of the groups at any time. At t(2) the casting group performed better than the taping and stretching groups at Modified Ashworth Scale and passive range of motion, and better than the stretching group at six-minute walking test (P < 0.02). Conclusions: Combining botulinum toxin type A to the ankle plantar flexors with casting or taping gives better and longer lasting results than with stretching alone.