Selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients: a 2-year longitudinal follow-up of 30 cases.
OBJECTIVE
To assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients.


METHODS
Intervention study (before-after trial) with an observational design and 2-year follow-up.


METHODS
Spasticity group in a university hospital.


METHODS
Hemiplegic patients (N=30) with spastic equinovarus foot.


METHODS
A selective neurotomy was performed at the level of the motor nerve branches of the tibial nerve.


METHODS
Spasticity (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.


RESULTS
Compared 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.


CONCLUSIONS
This 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.
Deltombe
Thierry
T
Spasticity Group, Department of Physical Medicine and Rehabilitation, Université catholique de Louvain, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium. thierry.deltombe@uclouvain.be
Gustin
Thierry
T
D000328:Adult; D000368:Aged; D003714:Denervation; D004863:Equinus Deformity / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006429:Hemiplegia / Q000150:complications* / Q000503:physiopathology; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D053580:Muscle Strength; D013979:Tibial Nerve / Q000601:surgery*