Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study

Spastic equinovarus (SEV) foot deformity is commonly observed in patients with post-stroke spasticity. Tibialis posterior (TP) is a common target for botulinum toxin type-A (BoNT-A) injection, as a first-line treatment in non-fixed SEV deformity. For this deep muscle, ultrasonographic guidance is cr...

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Autores principales:	Stefania Spina, Salvatore Facciorusso, Chiara Botticelli, Domenico Intiso, Maurizio Ranieri, Antonio Colamaria, Pietro Fiore, Chiara Ciritella, François Genêt, Andrea Santamato
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	BoNT-A ultrasound-guided injection spastic equinovarus foot tibialis posterior muscle stroke Medicine R
Acceso en línea:	https://doaj.org/article/9bdac4387bb84d88a049bfede698f5ee
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spelling	oai:doaj.org-article:9bdac4387bb84d88a049bfede698f5ee2021-11-25T19:09:12ZUltrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study10.3390/toxins131108292072-6651https://doaj.org/article/9bdac4387bb84d88a049bfede698f5ee2021-11-01T00:00:00Zhttps://www.mdpi.com/2072-6651/13/11/829https://doaj.org/toc/2072-6651Spastic equinovarus (SEV) foot deformity is commonly observed in patients with post-stroke spasticity. Tibialis posterior (TP) is a common target for botulinum toxin type-A (BoNT-A) injection, as a first-line treatment in non-fixed SEV deformity. For this deep muscle, ultrasonographic guidance is crucial to achieving maximum accuracy for the BoNT-A injection. In current clinical practice, there are three approaches to target the TP: an anterior, a posteromedial, and a posterior. To date, previous studies have failed to identify the best approach for needle insertion into TP. To explore the ultrasonographic characteristics of these approaches, we investigated affected and unaffected legs of 25 stroke patients with SEV treated with BoNT-A. We evaluated the qualitative (echo intensity) and quantitative (muscle depth, muscle thickness, overlying muscle, subcutaneous tissue, cross-sectional area) ultrasound characteristics of the three approaches for TP injection. In our sample, we observed significant differences among almost all the parameters of the three approaches, except for the safety window. Moreover, our analysis showed significant differences in cross-sectional area between treated and untreated. Advantages and disadvantages of each approach were investigated. Our findings can thus provide a suitable reference for clinical settings, especially for novice operators.Stefania SpinaSalvatore FacciorussoChiara BotticelliDomenico IntisoMaurizio RanieriAntonio ColamariaPietro FioreChiara CiritellaFrançois GenêtAndrea SantamatoMDPI AGarticleBoNT-A ultrasound-guided injectionspastic equinovarus foottibialis posterior musclestrokeMedicineRENToxins, Vol 13, Iss 829, p 829 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	BoNT-A ultrasound-guided injection spastic equinovarus foot tibialis posterior muscle stroke Medicine R
spellingShingle	BoNT-A ultrasound-guided injection spastic equinovarus foot tibialis posterior muscle stroke Medicine R Stefania Spina Salvatore Facciorusso Chiara Botticelli Domenico Intiso Maurizio Ranieri Antonio Colamaria Pietro Fiore Chiara Ciritella François Genêt Andrea Santamato Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study
description	Spastic equinovarus (SEV) foot deformity is commonly observed in patients with post-stroke spasticity. Tibialis posterior (TP) is a common target for botulinum toxin type-A (BoNT-A) injection, as a first-line treatment in non-fixed SEV deformity. For this deep muscle, ultrasonographic guidance is crucial to achieving maximum accuracy for the BoNT-A injection. In current clinical practice, there are three approaches to target the TP: an anterior, a posteromedial, and a posterior. To date, previous studies have failed to identify the best approach for needle insertion into TP. To explore the ultrasonographic characteristics of these approaches, we investigated affected and unaffected legs of 25 stroke patients with SEV treated with BoNT-A. We evaluated the qualitative (echo intensity) and quantitative (muscle depth, muscle thickness, overlying muscle, subcutaneous tissue, cross-sectional area) ultrasound characteristics of the three approaches for TP injection. In our sample, we observed significant differences among almost all the parameters of the three approaches, except for the safety window. Moreover, our analysis showed significant differences in cross-sectional area between treated and untreated. Advantages and disadvantages of each approach were investigated. Our findings can thus provide a suitable reference for clinical settings, especially for novice operators.
format	article
author	Stefania Spina Salvatore Facciorusso Chiara Botticelli Domenico Intiso Maurizio Ranieri Antonio Colamaria Pietro Fiore Chiara Ciritella François Genêt Andrea Santamato
author_facet	Stefania Spina Salvatore Facciorusso Chiara Botticelli Domenico Intiso Maurizio Ranieri Antonio Colamaria Pietro Fiore Chiara Ciritella François Genêt Andrea Santamato
author_sort	Stefania Spina
title	Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study
title_short	Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study
title_full	Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study
title_fullStr	Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study
title_full_unstemmed	Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study
title_sort	ultrasonographic evaluation of three approaches for botulinum toxin injection into tibialis posterior muscle in chronic stroke patients with equinovarus foot: an observational study
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/9bdac4387bb84d88a049bfede698f5ee
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Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study

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