title: Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: safety and changes in gait parameters.
abstract: BACKGROUND
  Equinovarus foot deformity (EVFD) compromises several prerequisites of walking and increases the risk of falling. Guidelines on rehabilitation following EVFD surgery are missing in current literature.
  
  
  OBJECTIVE
  The aim of this study was to analyze safety and adherence to an early rehabilitation treatment characterized by immediate weight bearing with an ankle-foot orthosis (AFO) in hemiplegic patients after EVFD surgery and to describe gait changes after EVFD surgical correction combined with early rehabilitation treatment.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Inpatient rehabilitation clinic.
  
  
  METHODS
  Forty-seven adult patients with hemiplegia consequent to ischemic or haemorrhagic stroke (L/R 20/27, age 56±15 years, time from lesion 6±5 years).
  
  
  METHODS
  A specific rehabilitation protocol with a non-articulated AFO, used to allow for immediate gait training, started one day after EVFD surgery. Gait analysis (GA) data before and one month after surgery were analyzed. The presence of differences in GA space-time parameters, in ankle dorsiflexion (DF) values and peaks at initial contact (DF at IC), during stance (DF at St) and swing (DF at Sw) were assessed by the Wilcoxon Test while the presence of correlations between pre- and post-operative values by Spearman's correlation coefficient.
  
  
  RESULTS
  All patients completed the rehabilitation protocol and no clinical complications occurred in the sample. Ankle DF increased one month after surgery at all investigated gait phases (Wilcoxon Test, P<0.0001), becoming neutral at IC. Significant (P<0.05) variations were found for stride length, stride width, anterior step length of the affected side and for the duration of the double support phase of the contralateral side. The postsurgery ankle DF at St was found to be correlated (R=0.81, P<0.0001) with its pre-surgery value, thus being predictable. Weaker significant correlations were found for DF at Sw and DF at IC, where contribution from the dorsiflexor muscles is required in addition to calf muscle passive lengthening.
  
  
  CONCLUSIONS
  An orthosis-assisted immediate rehabilitation associated with surgical procedure is safe and may be suitable to correct EVFD by restoring both the neutral heel foot-ground contact and the ankle DF peaks during stance and swing at one month from surgery.
  
  
  CONCLUSIONS
  The proposed protocol is a safe and potentially useful rehabilitative approach after EVFD surgical correction in stroke patients.
authors.affiliation: Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy - erikagiannotti@yahoo.it.
authors.forename: Erika
authors.initials: E
authors.lastname: Giannotti
authors.forename: Andrea
authors.initials: A
authors.lastname: Merlo
authors.forename: Paolo
authors.initials: P
authors.lastname: Zerbinati
authors.forename: Maria
authors.initials: M
authors.lastname: Longhi
authors.forename: Paolo
authors.initials: P
authors.lastname: Prati
authors.forename: Stefano
authors.initials: S
authors.lastname: Masiero
authors.forename: Davide
authors.initials: D
authors.lastname: Mazzoli
mesh_terms: D001696:Biomechanical Phenomena; D003025:Clubfoot / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005684:Gait / Q000502:physiology*; D006429:Hemiplegia / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012135:Respiratory Sounds / Q000502:physiology; D012189:Retrospective Studies; D012449:Safety; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation / Q000379:methods*; D016474:Weight-Bearing