Quantitative assessment of anaesthetic nerve block and neurotomy in spastic equinus foot: a review of two cases.
OBJECTIVE
To quantitatively evaluate the effect of motor nerve branch block and neurotomy of the soleus nerve on triceps surae spasticity, reviewing 2 cases.


METHODS
Beside clinical assessment, we carried out a quantitative measurement of the stiffness of the ankle flexor muscles. The path length of the phase diagram between elastic and viscous stiffness quantifies the reflex response to movement and reflects the importance of the spasticity. The assessments were carried out before and 30 min after motor nerve branch block of the upper soleus nerve and more than 7 months after neurotomy.


RESULTS
Both patients presented with pronounced ankle plantar flexor spasticity: their path lengths were more than 6 times greater than normal values at baseline (#1: 354 N m rad(-1); #2: 409 N m rad(-1)). Motor nerve branch block and neurotomy allowed a near-normalization of elastic and viscous stiffness of ankle plantar flexor muscles in the 2 patients. Their path length was almost similarly improved by motor nerve branch block (#1: 127 N m rad(-1); #2: 231 N m rad(-1)) and neurotomy (#1: 60 N m rad(-1); #2: 162 N m rad(-1)).


CONCLUSIONS
These case reports highlight the fundamental role of the soleus muscle in triceps surae spasticity in our patients, the predictivity of motor nerve branch block in the preoperative assessment, and the effectiveness of soleus neurotomy in spastic equinus foot.
Bleyenheuft
Corinne
C
Physical Medicine and Rehabilitation Department, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium. corinne.bleyenheuft@uclouvain.be
Detrembleur
Christine
C
Deltombe
Thierry
T
Fomekong
Edward
E
Lejeune
Thierry M
TM
D000368:Aged; D005260:Female; D005528:Foot / Q000503:physiopathology*; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D018482:Muscle, Skeletal / Q000293:injuries; D009407:Nerve Block / Q000379:methods; D016059:Range of Motion, Articular; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013979:Tibial Nerve / Q000601:surgery; D016896:Treatment Outcome