Épidémiologie des pieds varus et/ou équin un an après un premier accident vasculaire cérébral hémisphérique : à propos d'une cohorte de 86 patients

Verdié, C.; Daviet, Jean-Christophe; Borie, M.J.; Popielarz, S.; Munoz, Marguerite; Salle, Jean-Yves; Rebeyrotte, Isabelle; Dudognon, P

doi:10.1016/j.annrmp.2003.10.005

Cited by 35 publications

(5 citation statements)

References 15 publications

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“…In patients with lower limb spasticity after stroke, spastic equinus foot represents a prolonged abnormal lower limb posture and affects gait, standing, and transfer [2]. This deformity is reported in 18% of stroke patients [3]; spasticity of posterior muscles of the leg and weakness (especially the tibialis anterior and the peroneus muscle) with tendon shortening complicate balance and gait.…”

Section: Introductionmentioning

confidence: 99%

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Cinone

Letizia

Santoro

et al. 2019

Toxins

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Botulinum toxin A (BoNT-A) has been shown effective for poststroke lower limb spasticity. Following injections, a wide range of multidisciplinary approach has been previously provided. The purpose of this pilot, single-blind, randomized controlled trial was to determine whether BoNT-A combined with a regime of a four-week ankle isokinetic treatment has a positive effect on function and spasticity, compared with BoNT-A alone. Secondly, the validity of the use of an isokinetic dynamometer to measure the stretch reflex at the ankle joint and residual strength has been investigated. Twenty-five chronic stroke patients were randomized to receive combined treatment (n = 12; experimental group) or BoNT-A alone (n = 13; control group). Outcome measures were based on the International Classification of Functioning, Disability and Health. An isokinetic dynamometer was also used for stretch reflex and strength assessment. Patients were evaluated at baseline (t0), after five (t1) and eight weeks after the injection (t2). The experimental group reported significantly greater improvements on lower limb spasticity, especially after eight weeks from baseline. Gait speed (10-m walk test) and walking capacity (6-min walking test) revealed statistically significantly better improvement in the experimental than in control group. Peak resistive ankle torque during growing angular velocities showed a significant reduction at the higher velocities after BoNT-A injections in the experimental group. Peak dorsiflexor torque was significantly increased in the experimental group and peak plantarflexor torque was significantly decreased in control group. Alternative rehabilitation strategies that combine BoNT-A and an intense ankle isokinetic treatment are effective in reducing tone and improving residual strength and motor function in patients with chronic hemiparesis.

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Section: Introductionmentioning

confidence: 99%

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Cinone

Letizia

Santoro

et al. 2019

Toxins

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“…This may notably be explained by the fact that 92% of participants displayed dorsiflexion abnormalities in swing phase associated with a foot drop or equinus foot. This percentage may appear significant when compared to the literature (i.e., Verdie et al [ 27 ] reported approximately 18% of equinus foot and/or varus following a stroke), but must be considered in light of the fact that only hemiparetic adult patients with gait disorders were included in our study, as opposed to earlier studies. However, this factor is not restrictive for the use of the proposed classification, given that this abnormality is not necessarily represented in groups II and III ( Table 1 ).…”

Section: Discussionmentioning

confidence: 82%

Proposition of a Classification of Adult Patients with Hemiparesis in Chronic Phase

Chantraine¹,

Filipetti²,

Schreiber³

et al. 2016

PLoS ONE

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BackgroundPatients who have developed hemiparesis as a result of a central nervous system lesion, often experience reduced walking capacity and worse gait quality. Although clinically, similar gait patterns have been observed, presently, no clinically driven classification has been validated to group these patients’ gait abnormalities at the level of the hip, knee and ankle joints. This study has thus intended to put forward a new gait classification for adult patients with hemiparesis in chronic phase, and to validate its discriminatory capacity.Methods and FindingsTwenty-six patients with hemiparesis were included in this observational study. Following a clinical examination, a clinical gait analysis, complemented by a video analysis, was performed whereby participants were requested to walk spontaneously on a 10m walkway. A patient’s classification was established from clinical examination data and video analysis. This classification was made up of three groups, including two sub-groups, defined with key abnormalities observed whilst walking. Statistical analysis was achieved on the basis of 25 parameters resulting from the clinical gait analysis in order to assess the discriminatory characteristic of the classification as displayed by the walking speed and kinematic parameters. Results revealed that the parameters related to the discriminant criteria of the proposed classification were all significantly different between groups and subgroups. More generally, nearly two thirds of the 25 parameters showed significant differences (p<0.05) between the groups and sub-groups. However, prior to being fully validated, this classification must still be tested on a larger number of patients, and the repeatability of inter-operator measures must be assessed.ConclusionsThis classification enables patients to be grouped on the basis of key abnormalities observed whilst walking and has the advantage of being able to be used in clinical routines without necessitating complex apparatus. In the midterm, this classification may allow a decision-tree of therapies to be developed on the basis of the group in which the patient has been categorised.

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“…It can be postulated that these findings may be due to several factors. Hemiplegic patients often have inadequate ankle dorsiflexion due to loss of motor control, spasticity of the gastrocnemius soleus or the invertor group, and/or ankle contracture [ 1 ]. These muscle changes affect functional ambulation, thereby resulting in an increased falling risk and mechanical stress on the lateral column of the foot while walking [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the affected side, muscular imbalance usually causes ankle and foot deformities. Inadequate ankle dorsiflexion and spasticity of the plantar flexors or invertors following stroke have been described [ 1 ]. Ankle equinus deformities are seen in up to 20% of stroke patients, and of these, equinovarus deformity is the most characteristic and the most frequently seen [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Anterior Talofibular Ligament Thickness in Patients with Chronic Stroke: An Ultrasonographic Study

Yıldızgören

Velioğlu

Demetgül

et al. 2017

Journal of Medical Ultrasound

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Background:Patients with equinovarus deformity have an increased risk of fall and ankle ligament injury, because of inappropriate prepositioning of the ankle at the end of the swing phase, and inadequate leg and ankle stability during the stance phase. Accordingly, the aim of this study is to compare anterior talofibular ligament (ATFL) thickness of chronic stroke patients with that of healthy individuals using ultrasonography.Methods:This was a case-control study conducted in a university hospital between July 2015 and July 2016. We included 38 patients [study group; mean age, 59.0 ± 11.1 years; mean body mass index (BMI), 25.4 ±4.3 kg/m2] and a control group of age-, sex-, and BMI-matched healthy individuals. Demographic and clinical characteristics of the patients (i.e., age, weight, height, Brunnstrom motor recovery stage, Functional Ambulation Scale, Ashworth Scale, and duration of hemiplegia) were recorded during their visits. Furthermore, ultrasound image of the ATFL was obtained from each ankle. The thickness of the ATFL was measured at the midpoint of the ligament between the attachments on the lateral malleolus and the talus using ultrasonography.Results:In the study group, the mean thickness of the ATFLs of the affected side (2.75 ± 0.41 mm) was thicker than both the unaffected side (2.42 ± 0.30 mm) and the healthy controls (2.35 ± 0.19 mm; p = 0.007, p < 0.001, respectively). No differences were seen between the two sides of the control group.Conclusion:Chronic stroke patients have a thicker ATFL on both the affected and unaffected sides, compared with healthy individuals. This architectural feature of the ATFL may be a result of equinovarus deformity together with spastic muscles. For this reason, early treatment of deformed ligaments and spastic muscles is needed to prevent equinovarus deformity in patients with stroke.

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Épidémiologie des pieds varus et/ou équin un an après un premier accident vasculaire cérébral hémisphérique : à propos d'une cohorte de 86 patients

Cited by 35 publications

References 15 publications

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Proposition of a Classification of Adult Patients with Hemiparesis in Chronic Phase

Assessment of the Anterior Talofibular Ligament Thickness in Patients with Chronic Stroke: An Ultrasonographic Study

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