“…There is great heterogeneity of attitudes, divided between neurological and tendinous procedures, due to the fact that they are performed by different surgical teams. For several years, the performance of all these procedures by the same teams has made it possible to refine the indications and to perform combined procedures ( 6 , 15 , 16 , 25 ). Few series have analyzed the results of this global management.…”
Section: Discussionmentioning
confidence: 99%
“…There are many surgical techniques, which act on the tendons, in order to lengthen them, to transfer them or both. The most frequently performed intervention is split anterior tibialis tendon transfer (SPLATT) ( 16 ). Most of the time we lengthen the triceps surae through the Achilles tendon lengthening (TL) or through the gastrocnemius and soleus aponeurectomy to treat equinus position ( 17 ).…”
Section: Introductionmentioning
confidence: 99%
“…More rarely, bony procedures (BPs) are necessary. The details of these different techniques and the current management strategy have been described in a more generic literature review on EVF of all etiologies ( 16 ), as well as following the DELPHI method ( 25 ). The choice of the techniques used and their possible combination is based on the clinical examination of the patient through a multidisciplinary approach ( 15 , 16 ).…”
Section: Introductionmentioning
confidence: 99%
“…The details of these different techniques and the current management strategy have been described in a more generic literature review on EVF of all etiologies ( 16 ), as well as following the DELPHI method ( 25 ). The choice of the techniques used and their possible combination is based on the clinical examination of the patient through a multidisciplinary approach ( 15 , 16 ). If non-operative techniques are insufficient, neuro-orthopedic surgery can correct the equinus, reduce spasticity, and provide plantigrade support.…”
IntroductionThe aim of this study was to realize a systematic review of the different ways, both clinical and instrumental, used to evaluate the effects of the surgical correction of an equinovarus foot (EVF) deformity in post-stroke patients.MethodsA systematic search of full-length articles published from 1965 to June 2021 was performed in PubMed, Embase, CINAHL, Cochrane, and CIRRIE. The identified studies were analyzed to determine and to evaluate the outcomes, the clinical criteria, and the ways used to analyze the impact of surgery on gait pattern, instrumental, or not.ResultsA total of 33 studies were included. The lack of methodological quality of the studies and their heterogeneity did not allow for a valid meta-analysis. In all, 17 of the 33 studies involved exclusively stroke patients. Ten of the 33 studies (30%) evaluated only neurotomies, one study (3%) evaluated only tendon lengthening procedures, 19 studies (58%) evaluated tendon transfer procedures, and only two studies (6%) evaluated the combination of tendon and neurological procedures. Instrumental gait analysis was performed in only 11 studies (33%), and only six studies (18%) combined it with clinical and functional analyses. Clinical results show that surgical procedures are safe and effective. A wide variety of different scales have been used, most of which have already been validated in other indications.DiscussionNeuro-orthopedic surgery for post-stroke EVF is becoming better defined. However, the method of outcome assessment is not yet well established. The complexity in the evaluation of the gait of patients with EVF, and therefore the analysis of the effectiveness of the surgical management performed, requires the integration of a patient-centered functional dimension, and a reliable and reproducible quantified gait analysis, which is routinely usable clinically if possible.
“…There is great heterogeneity of attitudes, divided between neurological and tendinous procedures, due to the fact that they are performed by different surgical teams. For several years, the performance of all these procedures by the same teams has made it possible to refine the indications and to perform combined procedures ( 6 , 15 , 16 , 25 ). Few series have analyzed the results of this global management.…”
Section: Discussionmentioning
confidence: 99%
“…There are many surgical techniques, which act on the tendons, in order to lengthen them, to transfer them or both. The most frequently performed intervention is split anterior tibialis tendon transfer (SPLATT) ( 16 ). Most of the time we lengthen the triceps surae through the Achilles tendon lengthening (TL) or through the gastrocnemius and soleus aponeurectomy to treat equinus position ( 17 ).…”
Section: Introductionmentioning
confidence: 99%
“…More rarely, bony procedures (BPs) are necessary. The details of these different techniques and the current management strategy have been described in a more generic literature review on EVF of all etiologies ( 16 ), as well as following the DELPHI method ( 25 ). The choice of the techniques used and their possible combination is based on the clinical examination of the patient through a multidisciplinary approach ( 15 , 16 ).…”
Section: Introductionmentioning
confidence: 99%
“…The details of these different techniques and the current management strategy have been described in a more generic literature review on EVF of all etiologies ( 16 ), as well as following the DELPHI method ( 25 ). The choice of the techniques used and their possible combination is based on the clinical examination of the patient through a multidisciplinary approach ( 15 , 16 ). If non-operative techniques are insufficient, neuro-orthopedic surgery can correct the equinus, reduce spasticity, and provide plantigrade support.…”
IntroductionThe aim of this study was to realize a systematic review of the different ways, both clinical and instrumental, used to evaluate the effects of the surgical correction of an equinovarus foot (EVF) deformity in post-stroke patients.MethodsA systematic search of full-length articles published from 1965 to June 2021 was performed in PubMed, Embase, CINAHL, Cochrane, and CIRRIE. The identified studies were analyzed to determine and to evaluate the outcomes, the clinical criteria, and the ways used to analyze the impact of surgery on gait pattern, instrumental, or not.ResultsA total of 33 studies were included. The lack of methodological quality of the studies and their heterogeneity did not allow for a valid meta-analysis. In all, 17 of the 33 studies involved exclusively stroke patients. Ten of the 33 studies (30%) evaluated only neurotomies, one study (3%) evaluated only tendon lengthening procedures, 19 studies (58%) evaluated tendon transfer procedures, and only two studies (6%) evaluated the combination of tendon and neurological procedures. Instrumental gait analysis was performed in only 11 studies (33%), and only six studies (18%) combined it with clinical and functional analyses. Clinical results show that surgical procedures are safe and effective. A wide variety of different scales have been used, most of which have already been validated in other indications.DiscussionNeuro-orthopedic surgery for post-stroke EVF is becoming better defined. However, the method of outcome assessment is not yet well established. The complexity in the evaluation of the gait of patients with EVF, and therefore the analysis of the effectiveness of the surgical management performed, requires the integration of a patient-centered functional dimension, and a reliable and reproducible quantified gait analysis, which is routinely usable clinically if possible.
“…It is important to discuss goals of care to understand the patient’s function/ambulatory status at baseline. 4 , 5 This surgical technique is not used to increase the motion of the foot and ankle but to create a reliable limb for transfers and modest ambulation ( Fig 1 , Video 1 ). Fig 1 Right lower extremity in a patient positioned supine who experienced an anoxic brain injury.…”
Section: Surgical Technique (With Video Illustration)mentioning
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