Article

Selective neurotomy is a permanent treatment of focal spasticity, and
its effectiveness in treating spastic equinovarus of the foot (SEF) was
previously suggested by a few nonrandomized and uncontrolled case-series studies.
This study is the first assessor-blinded, randomized, controlled
trial evaluating the effects of this treatment. METHODS:
Sixteen chronic stroke
patients presenting with SEF were randomized into 2 groups : 8 patients underwent
a tibial neurotomy and the remaining 8 received botulinum toxin (BTX) injections.
The soleus was treated in all patients, and the tibialis posterior and flexor
hallucis longus were treated in about half of patients.
The primary outcome was
the quantitative measurement of ankle stiffness (L-path), an objective
measurement directly related to spasticity. Participants were assessed by a blind
assessor before their intervention and at 2 and 6 months after treatment.
Evaluations were based on the 3 domains of the International Classification of
Functioning, Disability and Health (ICF). RESULTS: Compared with BTX, tibial
neurotomy induced a higher reduction in ankle stiffness. Both treatments induced
a comparable improvement of ankle kinematics during gait, whereas neither induced
muscle weakening. Activity, participation, and quality of life were not
significantly modified in either group. CONCLUSIONS:
This study demonstrates that
the tibial nerve neurotomy is an effective treatment of SEF, reducing the
impairments observed in chronic stroke patients. Future studies should be
conducted to confirm the long-term efficacy based on the ICF domains.

Langue : ANGLAIS