Comparison of botulinum toxin injection and neurotomy in patients with distal lower limb spasticity

Background and purpose: We compared the efficacy of botulinum toxin injection (BTI) and tibial nerve neurotomy (TNN) in an open-label study of 34 post-stroke hemiplegic patients with distal lower limb deformation. Methods: The dose of BT was 300 U (Botox). TNN was performed with a 6–12 month delay on the motor branches of the tibial nerve. Muscles to be treated were selected according to the distal deformity (equinus, varus and clawing toes). Patients were assessed following each treatment for spasticity, motor control, range of movements, balance, gait and the Rivermead Motor Assessment. Results: TNN (M3, M6 and Y1) resulted in a more significant effect than BTI (D15, M2 and M5) on most of the measures: ankle plantar flexor spasticity, range of movement in dorsiflexion and eversion, foot position in upright situation, Functional Ambulation Categories (barefoot), RMA, gait velocity (comfortable condition), subjective benefit and use of walking aids. Patients treated for tibialis posterior or flexor digitorum longus spasticity often complained of subjective sensory disorders at the plantar sole over a period of 4–6 weeks. Conclusion: In conclusion, TNN is more effective than BTI on most of the functional parameters. The interest of BTI lies in the preliminary testing of the efficacy of a technique for reducing spasticity on lower limb function.