15.1
Hemiplegic leg (lower leg level)
- 1.
Clinical feature (right hemiplegic leg at the picture): stereotype of hip internal rotation, lack of knee flexion, plantar flexion, and foot inversion (at the picture) or eversion, and toe flexion at standing. Pronounced while standing and walking.
- 2.
Botulinum toxin injection:
- a.
Primary target muscles: gastrocnemius (7-1 & 2), soleus (7-3)
- b.
Secondary target muscles:
tibialis posterior (7-8): in case of foot inversion.
peroneus (7-4 to 7-6): in case of foot eversion
flexor digitorum longus 7-11) & brevis (8-4): in case of significant toe flexions
- a.
15.2
In-toeing
- 1.
Clinical feature: toes turn inward commonly combined with foot inversion. It is resulted from pelvic anteversion, tibial torsion, or forefoot adduction (see 16. Deformities of foot). Depending on the level of abnormality, the injection target muscles are selected.
- 2.
Botulinum toxin injection:
- a.
Primary target muscles:
tibialis posterior (7- 8), abductor hallucis (8-1)
- b.
Secondary target muscles:
tibialis anterior (7-7): if foot inversion is so severe (tibialis anterior is a strong foot invertor).
tensor fascia lata (6-2): in case of hip internal rotation is present
gastrocnemius and soleus (7-1 to 7-3): in case of plantar flexion combined.
- a.
15.3
Out-toeing
