title: Spastic equinus foot: multicenter study of the long-term results of tibial neurotomy.
abstract: OBJECTIVE
  Tibial neurotomy is a surgical technique widely used for the treatment of spastic equinus foot, but it has rarely been evaluated. The primary objective of this prospective study was to provide an objective quantification of the long-term results of tibial neurotomy.
  
  
  METHODS
  This multicenter prospective study was conducted from 1999 to 2003. Fifty-five patients with spastic equinus foot were treated in five neurosurgical centers. Preoperative and postoperative clinical evaluation comprised description of the foot deformity, study of stretch reflexes, evaluation of the repercussions of the deformity, and gait analysis. Selective neurotomy was performed in all patients.
  
  
  RESULTS
  No postoperative complications were observed. The mean postoperative follow-up was 10 months. Tibial neurotomy improved the appearance of the foot (equinus and varus deformities, claw toes); the equinus score decreased from 1.54 to 0.273 after the operation. Stretch reflex scores were decreased significantly and for a long term after surgery; the mean triceps surae stretch reflex score decreased from 2.46 to 0.47. The angle of passive dorsiflexion of the ankle increased significantly (from -0.56 degrees to +6.85 degrees). Gait analysis demonstrated a statistically significant increase in the speed of the patient's gait after surgical treatment; the time taken by the patient to walk 10 m at a normal speed in shoes decreased from a mean of 55 seconds to 35.16 seconds. Postoperatively, 92.7% of preoperative objectives had been achieved.
  
  
  CONCLUSIONS
  Tibial neurotomy ensures long-term functional improvement of patients with spastic equinus foot. It provides a lasting response for these patients compared with other, more transient treatments.
authors.affiliation: Service de Neurochirurgie, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
authors.forename: Kevin
authors.initials: K
authors.lastname: Buffenoir
authors.forename: Thomas
authors.initials: T
authors.lastname: Roujeau
authors.forename: Françoise
authors.initials: F
authors.lastname: Lapierre
authors.forename: Philippe
authors.initials: P
authors.lastname: Menei
authors.forename: Dominique
authors.initials: D
authors.lastname: Menegalli-Boggelli
authors.forename: Patrick
authors.initials: P
authors.lastname: Mertens
authors.forename: Philippe
authors.initials: P
authors.lastname: Decq
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004863:Equinus Deformity / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000534:rehabilitation / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D013979:Tibial Nerve / Q000503:physiopathology / Q000601:surgery*; D013995:Time