Non-Operative — Botulinum Toxin (Botox) Injection - Lower Extremity

Children's Colorado / Center for Gait and Movement Analysis (CGMA) · CGMA Physical Therapy Team, Children's Colorado

Weight-Bearing

WBAT; normal activities resume day of procedure; onset of effect over several days (low muscle pull risk)

Key Restrictions

Contraindicated with sensitivity to injected medications; effect lasts ~2-4 months; initial functional decrease possible during adaptation; discomfort at injection site 24-48 hrs; serial casting may be added 1-2 wks post-injection if inadequate response

Timeline & Phases

Post-injection: PROM/AROM/resistive LE ROM and strengthening of injected and antagonist muscles; gait training (foot position, stride length, velocity); balance training (ankle strategies); neuromuscular re-education, surface EMG biofeedback, FES; orthotic/seating evaluation; ADL functional training; HEP with stretching/strengthening/positioning

Notes

Pediatric; indication is dynamic spasticity/tone with good passive ROM, or to augment serial casting; Botox Type A or Myoblock (Type B); e-stim for muscle localization; frequency: q3 months x2, then q6-9 months; casting may begin 1-2 wks post-injection if needed; Children's Colorado CGMA

Surgeon / Author

CGMA Physical Therapy Team, Children's Colorado

Published

October 2007