Article

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. PATIENTS AND
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. DISCUSSION: 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. LEVEL OF EVIDENCE: IV.
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Langue : FRANCAIS