Choosing a treatment The children’s Institue

Early intervention from a physical  TCI has a long history of excellence and is
therapist is standard of care. Immediate committed to using the most recent
intervention is recommended because: research when making recommendations
 equinus deformity increases based on child’s needs in conjunction with
your family’s beliefs and values.
energy expenditure
 As a part of a comprehensive exam, your
 limits participation
child will be assessed at an impairment
 decreases quality of life level, activity and functional level based
on outcome measures to determine the
Conservative and/or surgical treatment most appropriate interventions.
may be appropriate. Consult medical
professionals such as your physician or
physical therapist to receive evidence
based information and opinions tailored
to your child’s situation
Resources
learn more about CP and Spastic Equinus at:

 https://www.cdc.gov/ncbddd/cp/facts.html

 https://cerebralpalsy.org/about-cerebral-
palsy/treatment/medication/botox

 https://cpandspasticequinus.weebly.com/

 https://www.mayoclinic.org/diseases-
conditions/cerebral-palsy/symptoms-causes/syc-
20353999

 https://www.rchsd.org/programs-sesrvices/cerebral-
palsy-center/services/botox-treatment-for-spasticity/

 https://www.Stlouischildrens.org/out-services/center-
cerebral-palsy-spasticity/about-cerebral-palsy-
spasticity

 https://www.ucpcleveland.org/services-for-
children/serial-casting-program/ Spastic Equinus
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Treatment Options
Conservative treatment:
What is Spastic Equinus?
It is a condition in which the ankle is
lacking dorsiflexion or the ability to bend
in the upwards direction. Spastic Equinus
is a common deformity in children with
cerebral palsy that can result secondary
to spasticity, which is attribute to
peripheral and central nervous system
disorders.
Impact on walking…
The calf muscle is the most consistently
active muscle while walking by
controlling how fast the body moves
over the foot. The ankle must be able to
bend past neutral so the body can roll
overtop the ankle for a smooth walking
pattern
When the foot is swing through, it must
also be able to bend to neutral to be
able to clear the foot and avoid tripping
on the toes.
defined as using botulinum toxin
(botox) injection and/or serial casting
to manage spastic equinus.
 Most effective when combined with
physical therapy
 Both treatments can improve walking
pattern, range of motion, decrease pain
and stiffness, and delay possible
surgical intervention
Botox
o Blocks signal from nerve to
muscle which makes it contract
o this weakens the muscle
o provides relief from spasticity
symptoms up to 6 months
Serial casting
o Immobilizes the effected joint(s)
o Involves application of new cast
every 2 weeks with primary goal
of improving range of motion
Learn how a physical
therapist can be crucial
in determining the most
approriate intervention
for your child
Surgical procedures
It is recommended that conservative
treatment options are trialed first
Your child may be a candidate for
surgery based on patient and degree of
deformity.
Types of procedures:
 Tibialis anterior tendon shortening
(TATS) in combination with
Achilles tendon lengthening (TAL)
method
 TAT’s in combination with TAL
has been found to improve foot
positioning during gait