Split Anterior Tibialis Tendon Transfer (Splatt) and Achilles Tendon Lengthening for The Correction of The Varus Foot after Stroke a Prospective Longitudinal Study

Thierry Deltombe

doi:10.4172/2329-9096.s5-006

Abstract

Background: The imbalance between tibialis anterior and peroneus activation in the swing phase of gait after stroke is responsible for an ankle varus leading to foot instability and poor quality of gait. In such case, a split anterior tibialis tendon transfer (SPLATT) procedure is indicated to correct imbalance. The aim of the study was to prospectively evaluate the effect of the SPLATT procedure in varus foot after stroke. Methods: We prospectively evaluated 26 consecutive hemiplegic patients (mean age 48.3 ± 10.2 years) with a varus foot operated for a SPLATT and an Achilles tendon lengthening procedure with a 6 months follow-up. Before and 6 months after surgery, the spasticity (Ashworth scale), muscle strength (MRC scale), active and passive ankle range of motion, gait parameters (10 meter walking test), gait kinematics (video) and need for assistive device were assessed. Results: A decrease in triceps spasticity and an increase in ankle dorsiflexion were observed. The varus in swing and stance phase of gait was improved. After surgery, 90% of the patients didn’t fit their ankle foot orthosis in comparison with 30% before. In contrast, gait speed, proximal spasticity, hip and ankle gait kinematics and need for crutches remained unchanged. Conclusion: This study is the first prospective study using objective validated scales confirming that the SPLATT procedure in combination with Achilles tendon lengthening is able to correct the varus and to reduce the need for orthosis in stroke patients with varus foot. Level of Evidence: Level IV / Prospective longitudinal case series study

Highlights

Stroke is one of the main causes of avoidable mortality and a major cause of handicap worldwide [1]
From the 26 patients, all benefited from a split anterior tibial tendon transfer (SPLATT) procedure and 19 benefited from an additional Achilles tendon and flexor hallucis and digitorum longus lengthening at the same time
There was a statistically significant decrease in triceps spasticity and an increase in passive ankle dorsiflexion with extended knee and in active analytic ankle dorsiflexion. These improvements are associated to a decrease in varus position observed both in swing phase, at foot switch and in stance phase of gait while equinus remains unchanged

Summary

Introduction

Stroke is one of the main causes of avoidable mortality and a major cause of handicap worldwide [1]. An imbalance between the tibialis anterior and peroneus muscles activation may be responsible for a varus in swing phase leading to a poor positioning of the foot at the beginning of the stance phase and to foot instability Such imbalance can be the only cause of SEF and can be worsened by triceps muscle spasticity and/or contracture. When such imbalance is responsible for the equinovarus deformity, an ankle foot orthosis, a tibialis posterior transfer or a split anterior tibial tendon transfer (SPLATT) procedure is proposed. The imbalance between tibialis anterior and peroneus activation in the swing phase of gait after stroke is responsible for an ankle varus leading to foot instability and poor quality of gait In such case, a split anterior tibialis tendon transfer (SPLATT) procedure is indicated to correct imbalance. The aim of the study was to prospectively evaluate the effect of the SPLATT procedure in varus foot after stroke

Objectives

Methods

Results

Conclusion