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Post-Stroke SpasticityNCT07758322

Efficacy of Focused Shock Wave Therapy Before and After Botulinum Toxin Injection in Patients With Post-Stroke Spastic Equinus/Equinovarus Foot: A Randomized Clinical Trial

A study testing Botulinum toxin type A and Focal Extracorporeal Shock Wave Therapy (ESWT) in people with Post-Stroke Spasticity and Spastic Equinovarus Foot, run by María Belén Martínez Luna at 1 site in Spain.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

Spastic equinovarus foot is the most common lower limb motor impairment after stroke and has a significant impact on gait, mobility, and quality of life. Botulinum toxin type A (BoNT-A) is considered the first-line treatment for focal post-stroke spasticity. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Botulinum toxin type A and Focal Extracorporeal Shock Wave Therapy (ESWT)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
69 participants
Where
1 siteSpain
Study dates
10 Oct 2024to 8 Oct 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults aged 18 to 87 years.
  • Clinical diagnosis of chronic stroke.
  • Presence of unilateral spastic equinovarus foot.
  • Lower-limb spasticity requiring treatment with botulinum toxin type A.
  • Ability to understand the study procedures and provide written informed consent.

Who cannot join

  • Botulinum toxin type A injection in the affected lower limb within the previous 12 weeks.
  • Previous extracorporeal shock wave therapy in the affected lower limb within the previous 12 weeks.
  • Fixed ankle contracture preventing passive correction.
  • Other neurological or musculoskeletal disorders affecting gait assessment.
  • Pregnancy or breastfeeding.
  • Contraindications to botulinum toxin type A or extracorporeal shock wave therapy.
  • Severe cognitive impairment preventing participation or informed consent.
  • Participation in another interventional clinical trial.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Hospital Clinico San Carlos

    Madrid, Madrid, 28040

Other trials in Spain

About this study

Official title: Focused Shock Wave Therapy Before and After Botulinum Toxin Injection in Patients With Post-Stroke Spastic Equinus/Equinovarus Foot

Spastic equinovarus foot is the most common lower limb motor impairment after stroke and has a significant impact on gait, mobility, and quality of life. Botulinum toxin type A (BoNT-A) is considered the first-line treatment for focal post-stroke spasticity. Extracorporeal shock wave therapy (ESWT) has shown promising results as an adjunctive treatment; however, the optimal timing for its administration in combination with BoNT-A remains unknown.

This prospective, randomized, evaluator-blinded clinical trial aims to determine whether focal ESWT administered before or after BoNT-A injection is more effective than BoNT-A alone in patients with chronic post-stroke spastic equinovarus foot. Sixty-nine participants will be randomly allocated to one of three treatment groups: (1) BoNT-A alone; (2) one session of focal ESWT immediately before BoNT-A injection; or (3) one session of focal ESWT two weeks after BoNT-A injection. The primary outcome is spasticity measured with the Modified Ashworth Scale (MAS). Secondary outcomes include the Modified Tardieu Scale, passive ankle range of motion, muscle strength (MRC), 10-Meter Walk Test (10MWT), Functional Ambulation Classification (FAC), pain (VAS), Patient-Specific Assessment Scale (PSAS), muscle echogenicity using the Heckmatt scale, and muscle stiffness assessed by real-time elastography. Assessments will be performed at baseline and during follow-up through week 54.

Read the detailed description

Stroke is one of the leading causes of long-term disability worldwide. Lower limb spasticity develops in a substantial proportion of stroke survivors, with the spastic equinovarus foot representing the most common gait pattern impairment. This condition negatively affects walking ability, balance, activities of daily living, and quality of life.

Botulinum toxin type A (BoNT-A) is considered the standard treatment for focal post-stroke spasticity. Nevertheless, its clinical effect is temporary and additional therapeutic strategies are needed to optimize and prolong treatment benefits. Extracorporeal shock wave therapy (ESWT) is a non-invasive intervention that has demonstrated beneficial effects on muscle tone, muscle stiffness, pain, and functional recovery. Experimental and clinical evidence suggests that ESWT may enhance the effects of BoNT-A, although the optimal timing of ESWT administration has not yet been established.

This study is a prospective, randomized, single-blind, three-arm clinical trial conducted at the Department of Physical and Rehabilitation Medicine of Hospital Clínico San Carlos (Madrid, Spain). Participants with chronic post-stroke spastic equinovarus foot who meet the eligibility criteria will be randomly assigned to one of three treatment groups:

Group A: BoNT-A injection alone.

Group B: One session of focal ESWT immediately before BoNT-A injection.

Group C: BoNT-A injection followed by one session of focal ESWT two weeks later. PROYECTO TESIS.docx

The primary outcome is lower limb spasticity measured using the Modified Ashworth Scale (MAS). Secondary outcomes include the Modified Tardieu Scale, passive ankle dorsiflexion range of motion, muscle strength measured by the Medical Research Council (MRC) scale, gait performance assessed by the 10-Meter Walk Test (10MWT) and Functional Ambulation Classification (FAC), pain assessed by the Visual Analogue Scale (VAS), patient-reported function using the Patient-Specific Assessment Scale (PSAS), muscle echogenicity using the Heckmatt scale, and muscle stiffness evaluated by real-time elastography. PROYECTO TESIS.docx

Clinical and ultrasound evaluations will be performed at baseline and at 4, 12, 24, 28, 42, and 54 weeks after treatment. The findings are expected to clarify whether the timing of focal ESWT administration influences the effectiveness of BoNT-A in the treatment of post-stroke spastic equinovarus foot and may contribute to optimizing rehabilitation protocols.

Being tested
Botulinum toxin type A, Focal Extracorporeal Shock Wave Therapy (ESWT)
Keywords
Botulinum Toxin A, Extracorporeal Shock Wave Therapy, Equinovarus Foot, Spasticity, ESWT, Stroke
Medical subject headings
Muscle Spasticity, Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Botulinum toxin type ADrug

    Also called OnabotulinumtoxinA

    Botulinum toxin type A (Botox®, onabotulinumtoxinA) injected under ultrasound guidance into the spastic lower-limb muscles according to each participant's clinical presentation and the study protocol. Injection sites and doses are individualized based on the pattern and severity of spasticity.

  • Focal Extracorporeal Shock Wave Therapy (ESWT)Device

    One session of focal extracorporeal shock wave therapy (ESWT) applied to the spastic calf muscles according to the study protocol using standardized treatment parameters.

Study groups in NCT07758322
Study groupRoleWhat they receive
Botulinum toxin type A aloneActive comparatorParticipants assigned to the control group receive botulinum toxin type A (Botox®, onabotulinumtoxinA) alone, injected under ultrasound guidance into the spastic lower-limb muscles according to the study protocol. No extracorporeal shock wave therapy is administered.
Receives: Drug: Botulinum toxin type A
Focal ESWT Before Botulinum Toxin Type AExperimentalParticipants receive one session of focal extracorporeal shock wave therapy immediately before botulinum toxin type A (Botox®, onabotulinumtoxinA) injection into the spastic lower-limb muscles.
Receives: Drug: Botulinum toxin type A; Device: Focal Extracorporeal Shock Wave Therapy (ESWT)
Focal ESWT After Botulinum Toxin Type AExperimentalParticipants receive botulinum toxin type A (Botox®, onabotulinumtoxinA) injection into the spastic lower-limb muscles, followed by one session of focal extracorporeal shock wave therapy two weeks later.
Receives: Drug: Botulinum toxin type A; Device: Focal Extracorporeal Shock Wave Therapy (ESWT)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in spasticity assessed by the Modified Ashworth Scale (MAS)

    Change in lower-limb spasticity measured using the Modified Ashworth Scale (MAS) after treatment.

    Measured: Baseline, 4, 12, 24, 28, 42 and 54 weeks.

Secondary outcomes (7)
  1. Modified Tardieu Scale

    Change in lower-limb spasticity assessed using the Modified Tardieu Scale, including the quality of muscle reaction and the angle of muscle reaction at different stretching velocities.

    Measured: Baseline, 4, 12, 24, 28, 42 and 54 weeks

  2. Change in passive ankle dorsiflexion range of motion

    Passive ankle dorsiflexion range of motion will be measured in degrees using a goniometer, with the knee flexed and extended. Higher values indicate greater ankle dorsiflexion.

    Measured: Baseline, 4, 12, 24, 28, 42 and 54 weeks

  3. Change in lower-limb muscle strength assessed by the Medical Research Council Scale

    Muscle strength will be assessed using the Medical Research Council Scale, ranging from 0 to 5, where 0 indicates no visible muscle contraction and 5 indicates normal muscle strength.

    Measured: Baseline, 4, 12, 24, 28, 42 and 54 weeks

  4. Change in gait speed assessed by the 10-Meter Walk Test

    Gait speed will be assessed using the 10-Meter Walk Test and expressed in meters per second. Higher gait speed indicates better walking performance.

    Measured: Baseline, 4, 12, 24, 28, 42 and 54 weeks

  5. Change in muscle echogenicity assessed by the Heckmatt Scale

    Muscle echogenicity will be assessed by ultrasound using the Heckmatt Scale, ranging from grade I to grade IV. Higher grades indicate increased muscle echogenicity and greater structural muscle alteration.

    Measured: Baseline, 4, 12, 24, 28, 42 and 54 weeks

  6. Change in pain intensity assessed by the Visual Analogue Scale

    Pain intensity associated with spasticity will be assessed using a Visual Analogue Scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain.

    Measured: Baseline, 4, 12, 24, 28, 42 and 54 weeks

  7. Change in patient-reported function assessed by the Patient-Specific Assessment Scale

    Patient-reported difficulty with activities affected by spastic equinovarus foot will be assessed using the Patient-Specific Assessment Scale. The evaluated activities include maintaining balance, walking quickly, climbing stairs, descending stairs, and putting on shoes.

    Measured: Baseline, 4, 12, 24, 28, 42 and 54 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Aug 2026
  2. Study start10 Oct 2024
  3. Primary completion8 Oct 2026 (estimated)
  4. Study completion8 Oct 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants will be randomly assigned in a 1:1:1 ratio to one of three parallel groups: (1) botulinum toxin type A (BoNT-A) alone; (2) focal extracorporeal shock wave therapy (ESWT) immediately before BoNT-A injection; or (3) focal ESWT administered two weeks after BoNT-A injection. Participants will remain in their assigned group throughout the study.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
69 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07758322
Sponsor's protocol ID
24/132-EC_P
Status last verified
Aug 2026
First submitted
6 Aug 2026
Last updated
11 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data will not be shared because the study consent and ethics approval do not include public sharing of de-identified individual participant data

Questions about this trial

What is this clinical trial studying?

A study testing Botulinum toxin type A and Focal Extracorporeal Shock Wave Therapy (ESWT) in people with Post-Stroke Spasticity and Spastic Equinovarus Foot, run by María Belén Martínez Luna at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 11 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in spasticity assessed by the Modified Ashworth Scale (MAS) (time frame: Baseline, 4, 12, 24, 28, 42 and 54 weeks.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Aug 2026.

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