Equinus Foot Deformity Research Articles

Outcome measures for assessing the effectiveness of physiotherapy interventions on equinus foot deformity in post-stroke patients with triceps surae spasticity: A scoping review.

Equinus foot deformity (EFD) is the most common deviation after stroke. Several physiotherapy interventions have been suggested to treat it. However, studies evaluating the efficacy of these treatments vary widely in terms of assessment modalities, type of data analysis, and nomenclature. This scoping review aimed to map current available evidence on outcome measures and the modalities employed to assess the effectiveness of physiotherapy programs for the reduction of triceps surae (TS) spasticity and EFD in patients with stroke. Scoping review methodological frameworks have been used. Three databases were investigated. Primary literature addressing TS spasticity in adult patients with stroke using physiotherapy interventions was included. Findings were systematically summarized in tables according to the intervention used, intervention dosage, control group, clinical, and instrumental outcome measures. Of the 642 retrieved studies, 53 papers were included. TS spasticity was assessed by manual maneuvers performed by clinicians (mainly using the Ashworth Scale), functional tests, mechanical evaluation through robotic devices, or instrumental analysis and imaging (such as the torque-angle ratio, the H-reflex, and ultrasound images). A thorough critical appraisal of the construct validity of the scales and of the statistics employed was provided, particularly focusing on the choice of parametric and non-parametric approaches when using ordinal scales. Finally, the complexity surrounding the concept of "spasticity" and the possibility of assessing the several underlying active and passive causes of EFD, with a consequent bespoke treatment for each of them, was discussed. This scoping review provides a comprehensive description of all outcome measures and assessment modalities used in literature to assess the effectiveness of physiotherapy treatments, when used for the reduction of TS spasticity and EFD in patients with stroke. Clinicians and researchers can find an easy-to-consult summary that can support both their clinical and research activities.

Effect of surgical correction of equinus foot deformity on triceps surae spasticity in stroke patients

Equinus foot deformity (EFD) in stroke can be due to triceps surae (TS) spasticity. Aim of this work is to study the short-term effects of EFD surgical correction on TS spasticity in a sample of hemiplegic patients. A sample of 48 chronic stroke patients, 53(14) years, 19/29 R/L, 6(5) years after lesion, median FAC = 4, walking speed 0.51(0.28) m/s who underwent surgical TS lengthening was included in the study. TS spasticity was assessed through the Modified Tardieu Scale (MTS) before and 1 month after surgery both with the knee extended and flexed at 90 degrees (MTS_KE, MTS_KF). Before/after surgery MTS values were compared using the Wilcoxon test. Percentages of patients with worsened, unchanged and improved MTS scores were also computed and reported. Both MTS_KE and MTS_KF scores significantly decreased one month after surgery ( P = 0.002 and P < 0.001, respectively). MTS_KE score (see Fig. 1 ) worsened in 4 subjects (8%), was stable in 23 (48%) and improved in 21 subjects (44%). MTS_KF score worsened in 2 subjects (3%), was stable in 18 subjects (38%) and improved in 28 subjects (58%). Eight subjects were completely relieved from spasticity. Along with restoring ankle joint range of motion, surgical TS lengthening can also decrease muscle reflex overactivity. This is reasonably due to the reduction in spindle activation during the stretching maneuver consequent to the decrease in muscle shortening, passive tension and stiffness. This should reduce the reflex inputs to the spinal pathways involved in muscle tone control. In conclusion, FS can produce positive changes on TS spasticity in adult stroke survivors. A study on long-term effects is ongoing.

Management of postt aumatic flexion contracture in knee joint using Ilizarov technique

Objective To evaluate the effectiveness of correction of posttraumatic flexion contracture of knee (FCK) using Ilizarov technique.Methods Six male patients with posttraumatic FCK,aging from 9 to 43 years (mean,24.5 years),treated by using Ilizarov technique from January 2006 to December 2010,were retrospectively analyzed.The preoperative flexion deformity of knee ranged from 35° to 85° (mean,47.6°),and the range of motion ranged from 0° to 70° (mean,15.8°).Among them,five patients had old fracture of knee joint combined with equinus foot deformity (deformity ranging from 25° to 37°,with an average of 31.8°); one patient had femoral supracondylar fracture.We used circular external fixator to correct the FCK and equinus foot deformity gradually,the knee arthrodesis operation was performed in 4 patients because of the damaged hone structure and poor soft tissue condition.Results All patients were followed up for 12-22 months (mean,18 months).The flexion of knee joint was recoverd from preoperative 47.67°±18.63° to postoperative 9.33°±3.50°.Plantar flexion of ankle joint in five equinus foot deformity was recovered from preoperative 31.80°±4.65° to postoperative 3.00°±4.47°.The kuee joint was arthrodesised successfully in 4 patients and the other 2 patients got 30° and 75° ROM.All the patients can walk with a cane,and satisfied with the result of treatment.Pin-site infection was found in 4 patients and was controlled within two weeks.Conclusion Ilizarov technique is an effective treatment method for posttraumatic FCK.Knee arthrodesis should be performed when patients had damaged bone structure and poor soft tissue condition. Key words: Ilizarov technique; Knee joint; External fixators; Osteogenesis, distraction