Botulinum Toxin A for Improving Lack of Ankle Dorsiflexion Range of Motion After Major Burns—A Retrospective Chart Review

  • Kevin Vu
    Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center Dallas, Dallas, TX
    Search for articles by this author
  • Karen Kowalske
    Corresponding author Karen Kowalske, MD, Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center Dallas, 5223 Harry Hines Blvd, Dallas, TX 75390-9055.
    Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center Dallas, Dallas, TX
    Search for articles by this author
Published:August 19, 2019DOI:



      To review the effectiveness of botulinum toxin A (BTX-A) for treating the loss of maximum ankle dorsiflexion range of motion after burn injury.


      Retrospective chart review.


      Large urban burn center.


      Patients (3-51 y) with major burn injury and loss of ankle dorsiflexion range while hospitalized (N=5).


      BTX-A treatment in addition to standard care.

      Main Outcome Measures

      Maximum ankle dorsiflexion range of motion at time of treatment, 1 month and 3 months posttreatment.


      Patients’ total burn area ranged from 18% to 95%, and time from injury to BTX-A injection (80-125 units) was 19-93 days. Ankle range at the time of injection was −10 to −50 degrees, and all patients had improved ankle range at 1 month postinjection (−30 to +10 degrees). At 3 months postinjection, 3 participants had neutral ranges of motion that were relatively improved compared to preinjection ranges. Patients with additional complications or severe injury showed regression toward preinjection maximum ankle dorsiflexion range of motion.


      This retrospective study examines BTX-A as a potential tool for treating ankle plantar flexion contractures post major burn injury after failed conservative treatment. Initial review shows some patients may benefit from these injections, but more systematically designed studies are required to assess effectiveness. If effective, further investigation will be needed to validate and standardize treatment protocols, establish dosing, and assess long-term effectiveness in those with burn injury or severe complications.


      List of abbreviations:

      BTX-A (botulinum toxin A), EHL (extensor hallucis longus), ROM (range of motion), TBSA (total body surface area)
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