Thanks for that and all your points are valid. Splinting and regular physio are not an option due to location, cost and his intellectual limitations. Unfortunately serial casting won't currently be tolerated due to his irritable/aggitated daily moods swings (not violent just he preseverates on things which winds him up and results in high blood pressure). Orthotics are indeed a possibility and we are looking into finding the right person locally to assist with that. He has one pair of boots that have been made by a local cobbler which he does tolerate when it is cool. Right now it is in the high 30's and it's winter! so you get my drift. Thanks for the points again on spasticity as I did test PROM in a few positions and there is obviously muscle shortening involved. The degree of what is what is a little difficult as he was born like this bilaterally. It's does not look like a typical talipes presentation due to womb position as really he is simple walking on his toes. The rest of him seems rather normal in function although I did not get into looking at his hip region. That said this type of walking would only make things worse if that were the issue.

I have mentioned to the family that I am not sure how long botox would last but maybe as little as 6 weeks. I also don't know if you can partially 'relax' the muscle using it rather than fully inhibiting it? It's been a while since I worked in that area. Hence anyone who has input on that would be great. I'll try to get a photo that I can add to this posting tomorrow. Maybe even try a video on my digital camera.