Differential effects of extracorporeal shock wave therapy and botulinum toxin-A injection on post-burn contractures and gait kinematics in burn children.

Post-burn contracture is a complex and multi-factorial problem that requires intensive inputs from the burn-care staff. This study endeavored to evaluate the effectiveness of extracorporeal shockwave therapy and botulinum toxin-A for treating the post-burn plantar flexion contracture and optimizing ankle kinematics in burn children. Thirty-eight children with burn and plantar flexion contracture were randomized to receive the standard physical rehabilitation program (control group; n=13), unfocused extracorporeal shockwave therapy (0.2 mJ/mm2) once a week over four consecutive weeks in addition to the standard physical rehabilitation (n=12), or botulinum toxin-A injection (0.5-2 U kg-1/muscle group with maximum dose of 12 U kg-1/body weight) once at entry besides the standard physical rehabilitation (n=13). Dorsiflexion active range of motion and ankle kinematics were measured before and immediately after treatment. The post-treatment dorsiflexion active range of motion increased significantly in the extracorporeal shockwave therapy group (P=.025) and botulinum toxin-A group (P=.04) when compared to the control group. Likewise, the initial stance-dorsiflexion, stance-maximum dorsiflexion, and swing-peak dorsiflexion angle improved significantly in the extracorporeal shockwave therapy group (P<.001, P=.005, and P=.002 respectively) and botulinum toxin-A group (P=.004, P=.012, and P<.001 respectively) compared to the control group. No significant differences were observed between the extracorporeal shockwave therapy and botulinum toxin-A groups with respect to any of the measured variables. To conclude, extracorporeal shockwave therapy and botulinum toxin-A injection could be effectively used to treat post-burn plantar flexion contracture and to optimize the ankle kinematics during walking in children, without preference for either of them.