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Botulinum toxin type A (BoNT\u2010A) can modify foot deformity in other conditions of muscle imbalance. We tested the safety and effectiveness of BoNT\u2010A on pes cavus progression in pediatric CMT1A. A 24\u2010month, randomized, single\u2010blind trial of BoNT\u2010A was undertaken in 10 affected children (20 legs), aged 3\u201314 years. The treated leg received intramuscular BoNT\u2010A injections at 6\u2010month intervals in the tibialis posterior and peroneus longus. The control leg received no injections. Primary outcome was radiographic alignment at 24 months. Secondary outcomes were foot posture, ankle flexibility, and strength, assessed every 6 months. Radiographically, BoNT\u2010A produced a small non\u2010significant reduction in cavus progression. There was no effect of BoNT\u2010A on secondary outcomes. There were no serious adverse events. At 24 months, the intramuscular BoNT\u2010A injections proved safe and well\u2010tolerated but did not affect the progression of pes cavus in CMT1A. 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