title: Long-term neuromechanical results of selective tibial neurotomy in patients with spastic equinus foot.
abstract: BACKGROUND
  The neuromechanical consequences of tibial neurotomy have not been extensively studied.
  
  
  METHODS
  Fifteen patients were evaluated before and after selective tibial neurotomy (after 2 months and after 15 months) by means of clinical, neurophysiological [tendon (T) reflexes, Hoffmann (H) reflexes and maximum motor response, Mmax] and mechanical parameters (passive stiffness of plantar flexors at the ankle). The neurotomy concerned the soleus (100 % of cases), gastrocnemius (20 % of cases), posterior tibial (60 % of cases) and flexor digitorum longus (47 % of cases) nerves.
  
  
  RESULTS
  Neurotomy provided more than 90 % improvement of clinical spasticity scores, 20 % improvement of walking scores and the angle of passive dorsiflexion (APDF) of the ankle (mean angle: 7°), temporary reduction of the soleus Mmax (18 % at 2 months with return to the preoperative value at 15 months), and lasting reduction of the soleus Hmax/Mmax (68 % at 2 months, 78 % at 15 months) and T/Mmax (84 % at 2 months, 80 % at 15 months). M and H responses of the gastrocnemius (whether or not they were included in the neurotomy) were not modified, while T/Mmax decreased to the same degree as for soleus. Passive stiffness was lastingly decreased from 64.0 Nm/rad to 49.0 Nm/rad (2 months) and 49.5 Nm/rad (15 months).
  
  
  CONCLUSIONS
  Selective tibial neurotomy of the soleus nerve induces long-term reduction of reflex hyperexcitability and passive stiffness of plantar flexors in spastic patients, with no lasting impairment of motor efferents. In parallel, it modifies the tendon reflexes of synergistic muscles (gastrocnemius) not concerned by the neurotomy.
authors.affiliation: Université de Technologie de Compiègne UMR CNRS 7338 Biomécanique et Bioingénierie, 60319 60203, Compiègne cedex, France. kevin.buffenoirbillet@chu-nantes.fr
authors.forename: Kévin
authors.initials: K
authors.lastname: Buffenoir
authors.forename: Philippe
authors.initials: P
authors.lastname: Decq
authors.forename: Olivier
authors.initials: O
authors.lastname: Hamel
authors.forename: Daniel
authors.initials: D
authors.lastname: Lambertz
authors.forename: Chantal
authors.initials: C
authors.lastname: Perot
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000601:surgery*; D018482:Muscle, Skeletal / Q000294:innervation / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D013979:Tibial Nerve / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome; D055815:Young Adult