Effects of posterior tibial tendon transfer in post-stroke adults with spastic equinovarus foot deformity in a tertiary hospital in Iran

Abstract

The purpose of this study was to evaluate the results of traditional posterior tibial tendon transfer (PTT) surgery in adult patients with spastic equinovarus foot (SVEF) after a stroke, in order to identify the effectiveness of the surgical procedure.A total of twelve patients with systolic ventricular ejection fraction (SVEF) were subjected to percutaneous tenotomy and tenodesis (PTT) surgery, wherein the tendon was removed from its original attachment point and redirected anteriorly via the interosseous membrane without any division. The surgical results were evaluated during the six-month and twelve-month follow-up assessments. The functional scores were examined using the Stanmore questionnaire, and the range of motion of the affected foot was evaluated for dorsiflexion and plantarflexion at the six-month follow-up. Furthermore, radiological X-rays were acquired from every patient. A year after the operation, a thorough analysis of the patients' walking patterns in three dimensions was conducted. The measurements obtained were then compared to the initial data collected from each patient before the surgery.The patients' functional scores exhibited a substantial enhancement, rising from a low average score of fifty-three to an outstanding average score of eighty-five. Plantarflexion and ankle dorsiflexion both showed improvement, with ankle dorsiflexion demonstrating a statistically significant improvement (P < 0.001) compared to plantarflexion (P = 0.06). The Equinus and varus abnormalities were effectively corrected (P = 0.016) without any instances of under- or over-correction. The gait analysis revealed enhancements in the overall gait, as well as increased flexibility in the ankle and knee joints during the swinging phase of walking. The gait analysis included dynamic electromyography (EMG), which showed a substantial improvement in the gastrocnemius muscle after therapy (p = 0.025). Therefore, this initial phase investigation offers preliminary proof that the provided treatment can successfully enhance specific spatio-temporal gait metrics and muscle activation.