Spastic Equinovarus Research Articles

Split Posterior Tibial Tendon Transfer for Spastic Equinovarus Foot Deformity

This paper describes a simplified technique for split posterior tibial tendon transfer in the treatment of spastic equinovarus deformity of the foot. Thirteen children with spastic equinovarus foot deformities were treated at Children's Rehabilitative Services in Phoenix, Arizona, from 1983 to 1986. The technique was modified in 10 of the 13 patients by attaching the split posterior tibial tendon more proximally to the peroneus brevis, compared to a more distal attachment as described by other authors. The mean length of followup was 21 months. Eleven patients obtained a good or excellent result. Two patients were considered to have a fair result. No poor results or complications were noted in any of the patients. It was felt that the split posterior tibial tendon transfer was an effective procedure for correction of spastic equinovarus as reported by other authors. Modification of the technique significantly simplifies the operation by requiring less dissection while still producing favorable results.

Posterior tibial tendon transfer in spastic equinovarus.

Twenty-eight posterior tibial tendon transfers through the interosseous membrane were performed to correct spastic equinovarus. All patients improved their gait, and 82% discarded their brace. Foot striking at the beginning of the stance phase was good or satisfactory in 82%; 68% had a neutral position of the heel. The overall score was good in 68%, satisfactory in 21%, and poor in 11%. The main requirements for obtaining good results with this type of transfer are: no fixed varus deformity preoperatively, age at operation between 5 and 10 years, and reinsertion near the midline of the foot.

Anterior Transfer of the Long Toe Flexors for the Treatment of Spastic Equinovarus and Equinus Foot in Cerebral Palsy

Anterior transfer of the long toe flexors combined with the Baker procedure, or heel cord lengthening was used to correct equinus foot deformity in 21 patients with cerebral palsy. In more than two-thirds of the cases, heel-to-ball gait became possible. There were no significant recurrences that required re-operation. There were no complications caused by loss of original function in the long toe flexors even in younger patients. Excellent and good results were seen in 57.1% of the patients according to the overall results.

Anterior Transfer of the Long Toe Flexors for the Treatment of Spastic Equinovarus and Equinus Foot in Cerebral Palsy

Summary: Anterior transfer of the long toe flexors combined with the Baker procedure, or heel cord lengthening was used to correct equinus foot deformity in 21 patients with cerebral palsy. In more than two-thirds of the cases, heel-to-ball gait became possible. There were no significant recurrences that required re-operation. There were no complications caused by loss of original function in the long toe flexors even in younger patients. Excellent and good results were seen in 57.1% of the patients according to the overall results.

Intrinsic toe flexion deformity following correction of spastic equinovarus deformity in adults.

In the treatment of spastic equinovarus foot deformities in adults with neurologic impairment, various surgical procedures are used including the split anterior tibialis tendon transfer and tendo achilles lengthening. Release of the flexor hallucis longus and flexor digitorum longus tendons in the midfoot is routinely included with these procedures to correct or prevent toe curling. In follow-up, residual toe curling has been observed in some patients despite release of the long toe flexor tendons. This study was undertaken to investigate this problem and its consequences, treatment, and treatment success. Forty-one feet in 34 consecutive patients were examined for residual toe curling an average of 2.5 years postoperatively. Thirty-two feet (78%) were noted to have significant flexion deformities of the lesser toes. The residual toe curling caused pain in 72% of the feet and was associated with callosities on the dorsum of the toes in 59%. The incidence of residual toe curling secondary to spasticity of the flexor digitorum brevis and intrinsic muscles of the foot was similar in the patients who had sustained traumatic brain injury and in those who had suffered a cerebrovascular accident. Twelve of these feet (37%) underwent surgical release of the flexor digitorum brevis and intrinsic tendons to correct the toe curling. There were no complications of surgery and no recurrences of deformity following the surgery. A second surgical procedure to release the flexor digitorum brevis and intrinsic tendons to correct the toe curling was more commonly performed in the younger more active brain-injured patients than in the older stroke patients (44% versus 20%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

A Clinical Analysis on Split Posterior Tibial Tendon Transfers for Spastic Equinovarus Deformity in Cerebral Palsy

A Clinical Analysis on Split Posterior Tibial Tendon Transfers for Spastic Equinovarus Deformity in Cerebral Palsy

Electrostimulation in the treatment of spastic equinovarus foot in children

International Journal of Rehabilitation Research: September 1985 - Volume 8 - Issue 3 - p 41

10-year follow-up of split anterior tibial tendon transfer in cerebral palsied patients with spastic equinovarus deformity.

Split anterior tibial tendon transfer was performed on 21 patients (27 feet) with cerebral palsy and spastic equinovarus deformity. All patients required orthoses preoperatively. All but two patients are now community ambulators with improved gait and without need for orthoses. There was one recurrence of deformity.

Surgical correction of spastic equinovarus deformity in the adult head trauma patient.

The results of 59 surgical procedures for correction of spastic equinovarus deformity of the foot using the split anterior tibial tendon (SPLATT) were reviewed in 54 adults with traumatic head injury. The mean time of follow-up was 49.7 months. Thirty-nine individuals had hemiplegic involvement, three had triplegic involvement, and 12 were quadriplegic. Evaluation of the patterns of lower extremity muscle activity preoperatively by dynamic electromyography in 33 patients showed no significant difference from that seen in the hemiplegic stroke population, namely, spastic calf muscles with overactive toe flexors and anterior tibial muscle. At follow-up all feet were in a plantigrade position. The only complication was a superficial skin slough on the dorsum of the foot which healed uneventfully. Postoperatively, 18 extremities (31%) were brace-free. Forty-one extremities required support because of calf weakness, ataxia, or proprioceptive deficits. Of the 15 patients who were nonambulatory prior to surgery, nine (60%) became ambulatory. At follow-up 36 patients (67%) were independent ambulators, four (7%) required supervision assistance, two (4%) required standby assistance, and six (11%) required minimal assistance. The six individuals (11%) who remained maximally assisted or nonambulatory had improved wheelchair positioning and shoe wear. These results show that the split anterior tibial tendon transfer is a safe and effective procedure for the head trauma patient since it corrects the equinovarus deformity, allowing for improved shoe wear and wheelchair positioning in the nonambulatory individual and improved ambulation with decreased brace wear in the more functional patient.

Transposition of the posterior tibial tendon in spastic equinovarus.

Eleven posterior tibial tendon transfers were performed in eight patients with spastic equinovarus with an average follow-up of 3 years (range 1 1/2-6 1/2 years). The main goals--to eliminate the need for braces and to improve gait--were achieved in all patients. An adequate operation technique kept the well-known postoperative complications, e.g., valgus and calcaneal deformity, to a minimum.

Anterior transfer of the toe flexors for equinovarus deformity of the foot.

Anterior transfer of the long toe flexors was carried out for the treatment of spastic equinovarus foot deformity in both adults and children. Adults included those with hemiplegia subsequent to a stroke, spastic hemiplegia due to cerebral palsy and spastic spinal paraplegia. Most of the children had cerebral palsy. The transfer was indicated for an equinovarus foot with persistent activity of the toe flexors, which produced curling of the toes in the swing phase of the gait or a fixed hammer toe deformity. Fifty six patients were followed up for more than four years. In all cases correction of the equinovarus deformity was achieved and maintained. With satisfactory correction stability of the ankle improved, postural abnormalities during gait decreased and bracing was not required. This study demonstrates the advantage of the long toe flexors for muscle transfer in these patients. The length of tendon available permitted easy transfer to the metatarsal. The defunctioning of the spastic muscles allowed gait improvement and function of the tibialis posterior and tibialis anterior was preserved.

The Effects of the Corrective Operation to the Hemiplegic Foot Deformities Using Electromyographycal Evaluation

The pre and postoperative electromyographycal and ADL evaluations were made to the hemiplegic patients who had had spastic equinovarus, hammer toe deformities.Vulpius's procedure, tenotomies of flexor hallux longus et digitorum longus, lateral transfer of tibialis anterior and these combination were the method of choice used for these corrective operations.One of the results showed flexor synergy which had been sheltered behind extension synergy had become predominant, resulting in somewhat resemblance to the normal gait pattern, improving pt's ADL besides tenodesis effect made by these methods.There are, however, lots of factors influencing the results such as the degree of spasticity, hip-knee joint contracture.

Deformity of the Foot Following Anterior Transfer of the Posterior Tibial Tendon and Lengthening of the Achilles Tendon for Spastic Equinovarus

Twenty-four children with spastic equinovarus deformity due to cerebral palsy were treated by anterior transfer of the posterior tibial tendon and Achilles tendon lengthening. In five patients, the operation was performed on both sides, making a total of 29 feet available for evaluation after an average follow-up of five years. Only 38 per cent of the results were graded "good" or "satisfactory." Sixty-two per cent were rated as "poor" because of valgus, calcaneus or equinus deformity severe enough to require re-operation. The post-operative deformity was generally evident one or more years after surgery, often progressive, and more disabling as well as more difficult to correct than the original condition. Although the percentage of acceptable results was considerably higher for hemiplegic patients than for others in the study, we conclude that in this group and in all other categories of spastic patients anterior transfer of the posterior tibial tendon should not be performed.

Transfer of tibialis posterior tendon in cerebral palsy

Posterior tendon transfer to the dorsum of the foot through the interosseous membrans is an effective procedure for spastic equinovarus deformity. The complications of excessive calcaneal or excessive valgus deformity can be avoided if the transfer is not inserted too tightly with the foot in dorsiflexion and if it is not transferred to a cuboid insertion. Electromyographic activity was demonstrated in some of the transferred muscles during the swing phase of gait. Tendo achillis lengthening in association with posterior tibial transfer must be done judiciously to avoid deformity of the calcaneus.

Correction of spastic equinovarus deformity in elderly hemiplegics by tenotomies.

Correction of spastic equinovarus deformity in elderly hemiplegics by tenotomies.