Adult-onset hemiplegia

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

“…Table 4 shows previous studies evaluating the efficacy of the tibialis anterior transfer in case of adult spastic equinovarus foot. Several surgical techniques have been described: the SPLATT [4][5][6][7][8][9]12,13], the transfer of the entire tibialis anterior tendon [10,11] and the peroneus transfer to tibialis anterior [6]. Furthermore, the transfer was frequently associated to other surgical procedures such as Achilles tendon lengthening [4][5][6][7]10,11,13], toe flexors lengthening [5][6][7]13], talonavicular arthrodesis and tibial neurotomy [4].…”

“…Several surgical techniques have been described: the SPLATT [4][5][6][7][8][9]12,13], the transfer of the entire tibialis anterior tendon [10,11] and the peroneus transfer to tibialis anterior [6]. Furthermore, the transfer was frequently associated to other surgical procedures such as Achilles tendon lengthening [4][5][6][7]10,11,13], toe flexors lengthening [5][6][7]13], talonavicular arthrodesis and tibial neurotomy [4]. These studies have demonstrated an improvement in ambulatory status [4,5,[8][9][10]13], a reduction in walking aids (orthotics shoes and AFO) requirement (4-9,13) and, in contrast with our results, an improvement in gait speed [5,10].…”

“…The SPLATT procedure is a well-known technique recommended to correct imbalance and varus in the swing phase of gait. Several publications have studied the ability of the SPLATT procedure to correct the varus foot after stroke [3][4][5][6][7][8][9][10][11][12][13]. However, only two studies were prospective and none of them have studied spasticity, range of motion, gait speed or gait kinematics.…”

Management of Gait Impairments in Chronic Unilateral Upper Motor Neuron Lesions

“…These surgical interventions often remain underused, although the inability to easily achieve a plantigrade foot position with extended toes while loading the leg often causes huge functional problems. 6 As shown in the Table, 7,31,[33][34][35][36][37][38][39][40][41][42] formal evidence for surgical interventions to correct pes equi-novarus is sparse because of the absence of wellcontrolled studies, but clinical experience is extensive and consistently positive if surgery is indicated and performed by an experienced and dedicated team. An advantage of procedures to lengthen muscles is that concomitant spasticity is also markedly and often permanently reduced after surgery, perhaps owing to a shift in the mechanical threshold at which spasticity is triggered.…”

“…Although, to our knowledge, the effect of a SPLATT alone has not been investigated, a combined Achilles tendon lengthening and SPLATT procedure resulted in a spatiotemporal normalization of the single-stance and double-support phases of gait. 36 If the tibialis anterior muscle is too weak to perform a SPLATT, the possibility of a fusion of 1 or more tarsal joints remains. This fusion entails the advantage of less instability of the hindfoot during loading when walking barefoot.…”