title: Comparison between tibial nerve block with anaesthetics and neurotomy in hemiplegic adults with spastic equinovarus foot.
abstract: OBJECTIVE
  The aim of the study was to compare the effect of diagnostic motor nerve block with anaesthetics and of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic adults.
  
  
  METHODS
  In this prospective observational study, 30 hemiplegic adults with spastic equinovarus foot benefited from a diagnostic nerve block with anaesthetics followed by a selective tibial neurotomy performed at the level of the same motor nerve branches of the tibial nerve. Spasticity (Ashworth scale), muscle strength (Medical Research Council scale), passive ankle dorsiflexion (ROM), gait parameters (10 meters walking test) and gait kinematics (video assessment) were assessed before and after the nerve block and two months and two years after selective tibial neurotomy.
  
  
  RESULTS
  The decrease in spasticity and the improvement in gait kinematics were similar after the diagnostic nerve block and two months and two years after neurotomy. The diagnostic nerve block did not revealed the slight increase in gait speed and in tibialis anterior muscle strength that was observed two years after neurotomy.
  
  
  CONCLUSIONS
  This study suggests that diagnostic nerve block with anaesthetics and selective neurotomy equally reduce spasticity and improve gait in case of spastic equinovarus foot in hemiplegic adults. Diagnostic nerve block can be used as a valuable screening tool before neurotomy.
authors.affiliation: Departments of Physical Medicine and Rehabilitation (Deltombe and Bleyenheuft) and Neurosurgery (Gustin), CHU-UcL Dinant Godinne (université catholique de Louvain), 5530 Yvoir, Belgium. Electronic address: thierry.deltombe@uclouvain.be.
authors.forename: Thierry
authors.initials: T
authors.lastname: Deltombe
authors.affiliation: Departments of Physical Medicine and Rehabilitation (Deltombe and Bleyenheuft) and Neurosurgery (Gustin), CHU-UcL Dinant Godinne (université catholique de Louvain), 5530 Yvoir, Belgium.
authors.forename: Corinne
authors.initials: C
authors.lastname: Bleyenheuft
authors.affiliation: Departments of Physical Medicine and Rehabilitation (Deltombe and Bleyenheuft) and Neurosurgery (Gustin), CHU-UcL Dinant Godinne (université catholique de Louvain), 5530 Yvoir, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustin
mesh_terms: D000328:Adult; D000368:Aged; D000777:Anesthetics / Q000627:therapeutic use*; D001696:Biomechanical Phenomena; D003025:Clubfoot / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003714:Denervation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D006429:Hemiplegia / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D013979:Tibial Nerve / Q000601:surgery; D055815:Young Adult
chemical_list: D000777:Anesthetics
keywords: Equinovarus foot; Hemiplegia; Motor nerve block; Muscle spasticity; Neurotomy