Article

OBJECTIVE: To assess the long-term efficacy of selective tibial neurotomy in the
treatment of spastic equinovarus foot in hemiplegic patients. DESIGN:
Intervention study (before-after trial) with an observational design and 2-year
follow-up. SETTING: Spasticity group in a university hospital. PARTICIPANTS:
Hemiplegic patients (N=30) with spastic equinovarus foot. INTERVENTION: A
selective neurotomy was performed at the level of the motor nerve branches of the
tibial nerve. MAIN OUTCOME MEASURES: Spasticity (Ashworth scale), muscle strength
(Medical Research Council scale), passive ankle dorsiflexion, gait parameters (6
min walking test), and gait kinematics (video assessment) were assessed before
and at 2 months, 1 year, and 2 years after selective tibial neurotomy. RESULTS:
Compared with preoperative values, there was a statistically significant decrease
in triceps surae spasticity, an increase in gait speed, and a reduction in
equinus and varus in swing and stance phases at 2 months postoperatively. This
improvement persisted at 1 and 2 years after selective tibial neurotomy.
Selective tibial neurotomy does not induce permanent triceps muscle weakness or
triceps surae-Achilles' tendon complex shortening. CONCLUSION: This study
confirms the long-lasting beneficial effect of selective tibial neurotomy on
spasticity, gait speed, and equinovarus deformity in the treatment of spastic
equinovarus foot in hemiplegic patients.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS