title: Treatment of dystonia in extensor hallucis longus and digitorum muscles with neurotomy of the branches of the deep fibular nerve: Preliminary results.
abstract: BACKGROUND
  Dystonia in extensor hallucis and/or digitorum muscles can be observed in pyramidal and extrapyramidal lesions and results in pain in these toes, spontaneous or when walking, problems and discomfort when putting on shoes and socks, and cutaneous lesions on the toes. The objective of this study was to assess the efficacy and safety of deep fibular nerve neurotomy for the extensor hallucis longus (EHL) and/or the extensor digitorum longus (EDL) branches in the treatment of extension dystonia of the hallux and/or other toes.
  
  
  METHODS
  A deep fibular nerve neurotomy was performed in 20 patients (n=19 for the EHL, n=6 for the EDL). We retrospectively analyzed the treatment's efficacy and safety and assessed the patients' self-reported improvement and overall treatment satisfaction.
  
  
  RESULTS
  Dystonia totally disappeared in 15 cases (75%); it persisted at a minimal level in the other patients. The patients reported a decrease in pain (P<0.01) and fewer difficulties putting on shoes and socks (P<0.001) and had a high median level of satisfaction (8.5/10). Adverse effects were rare and transient. The identification of the nerve branches was sometimes difficult.
  
  
  CONCLUSIONS
  Deep fibular nerve neurotomy for the EHL and/or EDL branches seems to be an effective treatment for extension dystonia of the hallux and/or other toes and its consequences for the adult neurological patient. However, these encouraging preliminary results should be confirmed by prospective, longer-term studies.
authors.affiliation: Service de rééducation et convalescence neurologiques, hôpital Swynghedauw, CHRU de Lille, rue André Verhaeghe, 59037 Lille cedex, France. Electronic address: etienne.allart@chru-lille.fr.
authors.forename: E
authors.initials: E
authors.lastname: Allart
authors.affiliation: Service de rééducation et convalescence neurologiques, hôpital Swynghedauw, CHRU de Lille, rue André Verhaeghe, 59037 Lille cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Rogeau
authors.affiliation: Service d'orthopédie B, hôpital Roger-Salengro, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: M-Y
authors.initials: MY
authors.lastname: Grauwin
authors.affiliation: Service d'orthopédie B, hôpital Roger-Salengro, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Nachef
authors.affiliation: Laboratoire d'anatomie, faculté de médecine Henri-Warembourg, université de Lille 2, 59045 Lille cedex, France.
authors.forename: X
authors.initials: X
authors.lastname: Lannes
authors.affiliation: Service de rééducation et convalescence neurologiques, hôpital Swynghedauw, CHRU de Lille, rue André Verhaeghe, 59037 Lille cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Rousseaux
authors.affiliation: Service de médecine physique et de réadaptation, hôpital Swynghedauw, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Thevenon
authors.affiliation: Service d'orthopédie B, hôpital Roger-Salengro, CHRU de Lille, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine Henri-Warembourg, université de Lille 2, 59045 Lille cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Fontaine
mesh_terms: D000328:Adult; D004421:Dystonia / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009121:Muscle Denervation; D018482:Muscle, Skeletal / Q000294:innervation*; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D017060:Patient Satisfaction; D010543:Peroneal Nerve / Q000601:surgery*; D012189:Retrospective Studies; D014034:Toes / Q000294:innervation*
keywords: Claw; Dystonia; Hallux; Neurotomy; Spasticity; Stroke; Toe