Botulinum toxin A in hamstring spasticity

Hamstring injection of Botulinum toxin A (BtA) may have a role in the conservative management of flexed knee gait in cerebral palsy or in simulating the effect of surgery. Ten children who were likely to require future hamstring lengthening were injected. Short term outcome was assessed by clinical examination and 3-D gait analysis. Mean popliteal angle decreased by 16° and maximum knee extension in stance increased by 8°, the latter relapsing by 12 weeks. Mean pelvic tilt tended to increase suggesting that isolated hamstring weakening be approached with caution. Energy cost of walking was not significantly changed in six of the ten patients. A small increase in knee extension in stance was often associated with patient satisfaction. There are theoretical grounds for expecting an associated increased longitudinal muscle growth after BtA injection.