Outcomes of equinus/varus foot surgery in patients with spastic paresis: A retrospective study on 126 patients

Abstract

Equinovarus foot is the most frequent complication in patients suffering from spastic paresis. Surgical treatment of equinovarus spastic foot includes different kinds of surgery, such as: selective tibial neurotomy, lengthening of the gastrocnemii, soleus, or Achilles tendon, tendon transfer, or rear- and midfoot arthrodesis. So far, there is a lack of precise guidelines about the surgery to consider, for these patients according to their clinical situation. To describe the outcome and complications of equinovarus foot surgery. We performed an analytic, retrospective, single centre study. We included all patients with spastic paresis acquired after 18 years who were operated for an equinovarus foot, on a 12-year period. Four time points were studied: the preoperative situation, postoperative at 3 and 12 months, and the last assessment during follow-up. Considering three main clinical situations (dynamic equinus, fixed equinus and fixed rear and midfoot deformities), we described the surgical procedures and their outcomes. From 200 patients who underwent surgery, 126 feet were included. Forty-eight percent of patients presented with a dynamic equinus foot and had a neurotomy; in such cases 10% of surgery failed, whereas only 6% failed in fixed equinus. The rate of subjective success (assessed by the patients) was 86%. Thirty percent of patients experienced a revision surgery, and 15% presented with complications. Fifteen percent of patients had claw toes after surgery in each group. Five patients had bone surgery because of a fixed varus. The occurrence of postoperative neuropathic pain, was associated with neurotomy of the plantar nerve ( P < 0.01). Equinus/equinovarus foot is a complex situation in patients with spastic paresis. Several clinical pictures can be identified. An important variety of surgical procedures is performed in these patients. The predictive factors of failure and complications of such surgeries can be suggested from this study.