Selective neurotomy of the tibial nerve for treatment of spastic foot

Abstract

IntroductionSelective peripheral neurotomy (SPN) of the tibial nerve is indicated for the treatment of spastic deformities of the foot. ObjectiveThis retrospective study was done to evaluate the surgical results of SPN of tibial nerve in 16 patients who had spastic foot. MethodsThe male to female ratio was 2–1 (11 males and 5 females) and their ages ranged from 18 to 65years.All patients preoperatively had spasticity either G3 or G4 as measured by modified Ashworth scale. All cases underwent surgery in the form of variable combination of SPN of tibial nerve depending on the pattern and distribution of spasticity. Depending on the degree of preoperative spasticity, 50–80% of the isolated motor branches of fascicles were resected under the operating microscope. Mean postoperative follow up examination period was 24months. ResultsThere was no operative mortality. Two patients had wound infection. Transient paresis of flexors of the foot occurred in one patient that responded well to physical therapy. Sensor affections and trophic changes occurred in three patients. Postoperatively, all the patients had immediate improvement of their spasticity grade. After initial improvement, recurrence of spasticity occurred in one patient. Abnormal foot posture that was present in all cases improved in 15 patients (94%) postoperatively, while pain that was present in 25% of cases improved in all these cases postoperatively as measured by visual analog scale. Assessment of outcome after surgery was done by comparing modified Ashworth scale preoperatively and postoperatively. At the last follow up examination period, excellent results were obtained in 50% of patients, good results in 31% of patients, fair results in 13% of patients, and poor results in 6% of cases. ConclusionIn well-selected patients, SPN of tibial nerve can yield good effects on refractory spasticity of the foot and its consequences.