title: A randomized controlled trial of selective neurotomy versus botulinum toxin for spastic equinovarus foot after stroke.
abstract: BACKGROUND
  Selective neurotomy is a permanent treatment of focal spasticity, and its effectiveness in treating spastic equinovarus of the foot (SEF) was previously suggested by a few nonrandomized and uncontrolled case-series studies.
  
  
  OBJECTIVE
  This study is the first assessor-blinded, randomized, controlled trial evaluating the effects of this treatment.
  
  
  METHODS
  Sixteen chronic stroke patients presenting with SEF were randomized into 2 groups: 8 patients underwent a tibial neurotomy and the remaining 8 received botulinum toxin (BTX) injections. The soleus was treated in all patients, and the tibialis posterior and flexor hallucis longus were treated in about half of patients. The primary outcome was the quantitative measurement of ankle stiffness (L-path), an objective measurement directly related to spasticity. Participants were assessed by a blind assessor before their intervention and at 2 and 6 months after treatment. Evaluations were based on the 3 domains of the International Classification of Functioning, Disability and Health (ICF).
  
  
  RESULTS
  Compared with BTX, tibial neurotomy induced a higher reduction in ankle stiffness. Both treatments induced a comparable improvement of ankle kinematics during gait, whereas neither induced muscle weakening. Activity, participation, and quality of life were not significantly modified in either group.
  
  
  CONCLUSIONS
  This study demonstrates that the tibial nerve neurotomy is an effective treatment of SEF, reducing the impairments observed in chronic stroke patients. Future studies should be conducted to confirm the long-term efficacy based on the ICF domains.
authors.affiliation: 1Université Catholique de Louvain, Institute of Neurosciences, Brussels, Belgium.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bollens
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustin
authors.forename: Gaëtan
authors.initials: G
authors.lastname: Stoquart
authors.forename: Christine
authors.initials: C
authors.lastname: Detrembleur
authors.forename: Thierry
authors.initials: T
authors.lastname: Lejeune
authors.forename: Thierry
authors.initials: T
authors.lastname: Deltombe
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D004863:Equinus Deformity / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013979:Tibial Nerve / Q000601:surgery*
chemical_list: D019274:Botulinum Toxins, Type A
keywords: botulinum toxin; equinus deformity; neurotomy; spasticity; stroke rehabilitation