Selective Tibial Neurotomy in the Treatment of Spastic Equinovarus Foot in Hemiplegic Patients: A 2-Year Longitudinal Follow-Up of 30 Cases |
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Authors: | Thierry Deltombe Thierry Gustin |
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Institution: | a Spasticity Group, Department of Physical Medicine and Rehabilitation, Université catholique de Louvain, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium b Department of Neurosurgery, Université catholique de Louvain, Cliniques universitaires de Mont-Godinne, Yvoir, Belgium |
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Abstract: | Deltombe T, Gustin T. Selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients: a 2-year longitudinal follow-up of 30 cases.ObjectiveTo assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients.DesignIntervention study (before-after trial) with an observational design and 2-year follow-up.SettingSpasticity group in a university hospital.ParticipantsHemiplegic patients (N=30) with spastic equinovarus foot.InterventionA selective neurotomy was performed at the level of the motor nerve branches of the tibial nerve.Main Outcome MeasuresSpasticity (Ashworth scale), muscle strength (Medical Research Council scale), passive ankle dorsiflexion, gait parameters (6 min walking test), and gait kinematics (video assessment) were assessed before and at 2 months, 1 year, and 2 years after selective tibial neurotomy.ResultsCompared with preoperative values, there was a statistically significant decrease in triceps surae spasticity, an increase in gait speed, and a reduction in equinus and varus in swing and stance phases at 2 months postoperatively. This improvement persisted at 1 and 2 years after selective tibial neurotomy. Selective tibial neurotomy does not induce permanent triceps muscle weakness or triceps surae-Achilles' tendon complex shortening.ConclusionThis study confirms the long-lasting beneficial effect of selective tibial neurotomy on spasticity, gait speed, and equinovarus deformity in the treatment of spastic equinovarus foot in hemiplegic patients. |
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Keywords: | Hemiplegia Muscle spasticity Rehabilitation Stroke |
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