Article

OBJECTIVE: To present interdisciplinary practical guidance for the assessment and
treatment of spastic equinovarus foot after stroke. RESULTS: Clinical examination
and diagnostic nerve block with anaesthetics determine the relative role of the
factors leading to spastic equinovarus foot after stroke:
calf spasticity,
triceps surae - Achilles tendon complex shortening and dorsiflexor muscles
weakness and/or imbalance. Diagnostic nerve block is a mandatory step in
determining the cause(s) of, and the most appropriate treatment(s) for, spastic
equinovarus foot. Based on interdisciplinary discussion, and according to a
patient-oriented goal approach, a medical and/or surgical treatment plan is
proposed in association with a rehabilitation programme. Spasticity is treated
with botulinum toxin or phenol-alcohol chemodenervation and neurotomy, shortening
is treated by stretching and muscle-tendon lengthening,
and weakness is treated
by ankle-foot orthosis, functional electrical stimulation and tendon transfer.
These treatments are frequently combined. CONCLUSION:
Based on 20 years of
interdisciplinary expertise of management of the spastic foot, guidance was
established to clarify a complex problem in order to help clinicians treat spastic equinovarus foot. This work should be the first step in a more global
international consensus.

Langue : ANGLAIS