{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:13:52Z","timestamp":1790201632528,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T00:00:00Z","timestamp":1639267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Equinovarus foot is one of the most commonly spasticity related conditions in stroke survivors, leading to an impaired gait and poor functional performances. Notably, spastic muscles undergo a dynamic evolution following typical pathophysiological patterns. Botulinum Neurotoxin Type A (BoNT-A) is the gold standard for focal spasticity treatment, and ultrasound (US) imaging is widely recommended to guide injections and monitor muscle evolution. The role of BoNT-A in influencing muscle fibroadipose degeneration is still unclear. In this study, we analyzed medial gastrocnemius (MG) and soleus (SOL) US characteristics (cross-sectional area, muscle thickness, pennation angle, and mean echo intensity) in 53 patients. MG and SOL alterations, compared to the unaffected side, depend on the spasticity only and not on the BoNT-A treatment. In functionally preserved patients (functional ambulation classification, FAC &gt; 3; modified Ashworth scale, MAS \u2264 2), the ultrasonographic changes of MG compared to ipsilateral SOL observed in the paretic limb alone seems to be due to histological, anatomical, pathophysiological, and biomechanical differences between the two muscles. In subjects with poor walking capability and more severe spasticity, such ipsilateral difference was found in both calves. In conclusion, BoNT-A does not seem to influence muscle degeneration. Similar muscles undergo different evolution depending on the grade of walking deficit and spasticity.<\/jats:p>","DOI":"10.3390\/toxins13120889","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T01:29:33Z","timestamp":1639358973000},"page":"889","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Triceps Surae Muscle Characteristics in Spastic Hemiparetic Stroke Survivors Treated with Botulinum Toxin Type A: Clinical Implications from Ultrasonographic Evaluation"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1357-1374","authenticated-orcid":false,"given":"Marco","family":"Battaglia","sequence":"first","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cOspedale Maggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0221-7102","authenticated-orcid":false,"given":"Lucia","family":"Cosenza","sequence":"additional","affiliation":[{"name":"Rehabilitation Unit, Department of Rehabilitation, \u201cSanti Antonio e Biagio e Cesare Arrigo\u201d National Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Scotti","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Bertoni","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, ASST Sette Laghi, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Polverelli","sequence":"additional","affiliation":[{"name":"Rehabilitation Unit, Department of Rehabilitation, \u201cSanti Antonio e Biagio e Cesare Arrigo\u201d National Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8116-4802","authenticated-orcid":false,"given":"Alberto","family":"Loro","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cOspedale Maggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1452-8485","authenticated-orcid":false,"given":"Andrea","family":"Santamato","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Spasticity and Movement Disorder Unit, Policlinico Riuniti, Universit\u00e0 di Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8440-6283","authenticated-orcid":false,"given":"Alessio","family":"Baricich","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Health Sciences, Universit\u00e0 del Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cOspedale Maggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,12]]},"reference":[{"key":"ref_1","unstructured":"Feldman, R.G., Young, R.R., and Koella, W.P. 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