Abstract
BackgroundGait impairments are common and disabling in chronic stroke patients. Pes equinovarus deformity is one of the primary motor deficits underlying reduced gait capacity after stroke. It predisposes to stance-phase instability and subsequent ankle sprain or falls. This instability is most pronounced when walking barefoot. Tarsal fusion is a recommended treatment option for varus deformity, but scientific evidence is sparse. We therefore evaluated whether a tarsal fusion improved barefoot walking capacity in chronic stroke patients with pes equinovarus deformity.MethodsTen patients with a pes equinovarus deformity secondary to supratentorial stroke underwent surgical correction involving a tarsal fusion of one or more joints. Instrumented gait analysis was performed pre- and postoperatively using a repeated-measures design. Primary outcome measure was gait speed.ResultsWalking speed significantly improved by 32% after surgery (0.38 m/s ± 0.20 to 0.50 m/s ± 0.17, p = 0.007). Significant improvement was also observed when looking at cadence (p = 0.028), stride length (p = 0.016), and paretic step length (p = 0.005). Step length on the nonparetic side did not change. Peak ankle moment increased significantly on the nonparetic side (p = 0.021), but not on the paretic side (p = 0.580). In addition, functional ambulation scores increased significantly (p = 0.008), as did satisfaction with gait performance (p = 0.017).ConclusionsTarsal fusion for equinovarus deformity in chronic stroke patients improves gait capacity, and the degree of improvement is of clinical relevance. Our results suggest that the improved gait capacity may be related to better prepositioning and loading of the paretic foot, leading to larger paretic step length and nonparetic ankle kinetics.
Highlights
Gait impairments are common and disabling in chronic stroke patients, as they result in reduced mobility, falls and fall-related injuries. [1, 2] Pes equinovarus is one of the primary motor deficits underlying reduced gait capacity in these patients
We hypothesized that self-selected gait speed would increase after tarsal fusion in chronic stroke patients suffering from equinovarus deformity
Patients and intervention Between December 2014 and April 2017, we included chronic (> 6 months post onset) patients after supratentorial stroke who were evaluated at the mobility outpatient clinic of the Radboud university medical center and the Sint Maartenskliniek for gait problems due to stance-phase instability related to pes equinovarus, and who subsequently underwent a surgical intervention including a fusion of one or more tarsal joints
Summary
Gait impairments are common and disabling in chronic stroke patients, as they result in reduced mobility, falls and fall-related injuries. [1, 2] Pes equinovarus is one of the primary motor deficits underlying reduced gait capacity in these patients. [3] It is the result of imbalance of ‘active’ muscle strength (weakness of dorsiflexors and evertors) as well as ‘passive’ muscle length and tone (contractures and spasticity of the plantarflexors and invertors) around the ankle and tarsal joints. The varus deformity of the hindfoot is disabling, as it predisposes to stance-phase instability and subsequent ankle sprain or falls. This instability is most pronounced when walking barefoot, e.g. when going to the bathroom at night, and imposes a heavy attentional load on patients to prevent ankle sprain or falling. [6] We evaluated whether gait capacity in chronic stroke patients improves after a surgical correction of a pes equinovarus deformity. Pes equinovarus deformity is one of the primary motor deficits underlying reduced gait capacity after stroke It predisposes to stance-phase instability and subsequent ankle sprain or falls. We evaluated whether a tarsal fusion improved barefoot walking capacity in chronic stroke patients with pes equinovarus deformity
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