title: Surgery can reduce the nonoperative care associated with an equinovarus foot deformity.
abstract: Equinovarus is the most common lower extremity deformity seen after a stroke. Despite its frequency, there are no specific guidelines in determining when surgery should be considered and for which patients it is appropriate. We evaluated the charges of nonsurgical and surgical treatments for equinovarus foot in 29 consecutive patients who underwent surgery for a unilateral equinovarus deformity after stroke. Twenty-six patients (seven males, 19 females) were available for followup. Mean patient age at the time of stroke was 48.2 years (range, 3-66 years). The average age at surgery was 54.7 years (range, 23-72 years), with a mean duration of nonsurgical treatment of 74.7 months. The minimum followup was 6 months following surgery (mean, 18.2 months; range, 6-48 months). Physical therapy accounted for 88% of nonoperative charges, with chemodenervation and orthotics accounting for 10% and 2%, respectively. Postoperatively, 19 patients were able to discontinue physical therapy compared with none preoperatively, and 17 discontinued orthotic use. Surgical correction of the equinovarus foot, in the appropriate patient, can decrease the use of nonoperative care for a patient who has had a stroke. We recommend surgery be considered earlier when an equinovarus deformity persists after the period of spontaneous neurologic recovery.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Two Silverstein, Philadelphia, PA 19104, USA.
authors.forename: Sudheer
authors.initials: S
authors.lastname: Reddy
authors.forename: Sharat
authors.initials: S
authors.lastname: Kusuma
authors.forename: Harish
authors.initials: H
authors.lastname: Hosalkar
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Keenan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D003714:Denervation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D026741:Physical Therapy Modalities; D020521:Stroke / Q000150:complications*; D013997:Time Factors