Effects of tibial nerve neurotomy on posture and gait in stroke patients: A focus on patient-perceived benefits in daily life.
OBJECTIVE
To evaluate the objective and subjective functional effectiveness of tibial nerve neurotomy (TNN) in post-stroke spastic equinovarus foot (SEF).


METHODS
In an open study, 23 hemiplegic patients were assessed immediately before TNN and then 5months after TNN. The main outcome measure was the Lower Limb Function Assessment Scale (LL-FAS), which provided an ecologic assessment of impairments in standing and walking (i.e. kinematic abnormalities) and their impacts on activities of daily living. Patients were also assessed for global clinical impression of change, fear of falling, neuromotor impairments, spatiotemporal and video gait parameters and walking capacities.


RESULTS
TNN had a very marked effect on the level of spasticity and the range of motion in dorsiflexion (p<10(-3)). These changes resulted in better foot positioning when standing and walking (particularly in stance), which was perceived very favorably by the patients. There was a clear, patient-perceived improvement in activities performed when standing and walking (LL-FAS (p<0.01)), the global clinical impression of change (p<10(-3)) and the fear of falling (p=0.022) that was not revealed by conventional, objective measurements (New Functional Ambulation Classification, Rivermead Mobility Index).


CONCLUSIONS
TNN is an effective treatment for post-stroke SEF; it is associated with a patient-reported improvement in standing and walking abilities during activities of daily living. Further research must now assess the long-term subjective efficacy of TNN.
Neurorehabilitation Unit, Swynghedauw Hospital, Lille University Medical Center, F-59037 Lille, France; Neurorehabilitation Unit, Clinique Saint Martin, F-13396 Marseille, France.
Charlotte
C
Le Bocq
Neurorehabilitation Unit, Swynghedauw Hospital, Lille University Medical Center, F-59037 Lille, France.
Marc
M
Rousseaux
Functional Neurosurgery Unit, Roger Salengro Hospital, Lille University Medical Center, F-59037 Lille, France.
Nadia
N
Buisset
Neurorehabilitation Unit, Swynghedauw Hospital, Lille University Medical Center, F-59037 Lille, France.
Walter
W
Daveluy
Functional Neurosurgery Unit, Roger Salengro Hospital, Lille University Medical Center, F-59037 Lille, France.
Serge
S
Blond
Neurorehabilitation Unit, Swynghedauw Hospital, Lille University Medical Center, F-59037 Lille, France; Université de Lille, Inserm U1171-Troubles cognitifs dégénératifs et vasculaires, F-59000 Lille, France. Electronic address: Etienne.allart@chru-lille.fr.
Etienne
E
Allart
D000058:Accidental Falls; D000203:Activities of Daily Living; D001696:Biomechanical Phenomena; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology; D010045:Outpatients; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020521:Stroke / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D000071939:Stroke Rehabilitation / Q000379:methods*; D013979:Tibial Nerve / Q000601:surgery*; D016896:Treatment Outcome
Equinovarus foot; Gait; Neurotomy; Posture; Spasticity; Stroke