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Freezing in Parkinson disease helped by botulinum toxin

This woman has advanced Parkinson disease with characteristic signs, including rigidity (not shown), bradykinesia, poverty of associated movements, shuffling gait, and en bloc turning in small steps. She has frequent episodes of "freezing," especially while turning. During these episodes, her toes flex as in a foot grasp. She improves markedly after botulinum toxin injections into the toe flexors and posterior tibialis muscles. (Contributed by Dr. Joseph Jankovic.)