Plantar pressure displacement after anesthetic motor block and tibial nerve neurotomy in spastic equinovarus foot

Abstract

Abstract-The aim of this study was to analyze the displacements of center of pressure (COP) using an in-shoe recording system (F-Scan) before and after motor nerve block and neurotomy of the tibial nerve in spastic equinovarus foot. Thirty-nine patients (age 45 +/-15 yr) underwent a motor nerve block; 16 (age 38 +/-15.2 yr) had tibial neurotomy, combined with tendinous surgery (n = 9). The displacement of the COP (anteroposterior [AP], lateral deviation [LD], posterior margin [PM]) was compared between paretic and nonparetic limbs before and after block and surgery. At baseline, the nonparetic limb had a higher AP (17.3 vs 12.3 cm, p < 0.001) and LD (4.0 vs 3.3 cm, p = 0.001) and a smaller PM (2.9 vs 4.7 cm, p = 0.001). For the paretic limb, a significant increase of AP was observed after block (13.5 vs 12.3 cm, p = 0.02) and after surgery (13.7 vs 12.3 cm, p = 0.03). A significant decrease of PM was observed after surgery (4.5 vs 3.3 cm, p < 0.001) with no more difference between two limbs (2.8 vs 3.3 cm, p = 0.44). This study shows that the F-Scan system can be used to quantify impairments and be useful to evaluate the effects of treatment for spastic foot. It suggests that changes in AP displacement following block may predict the effects of neurotomy.

Evaluation methods to assess the efficacy of equinovarus foot surgery on the gait of post-stroke hemiplegic patients: A literature review

“…For Giannotti et al ( 48 , 49 ), gait stability and symmetry were represented by anterior step length and double support time but without any analysis. The authors did not recover the raw data ( 51 , 58 ), and data analysis was performed by engineers or software, so the method used to obtain the results was not explicit and therefore not reproducible. Kinematics analysis evaluated ankle ROM and sometimes knee ROM.…”

Neuro-Orthopedic Surgery for Equinovarus Foot Deformity in Adults: A Narrative Review

“…Our search of electronic literature databases identified 113 publications, 33 of which presented efficacy results (covering a total of 1010 participants) and were included in the present review. Seventeen publications referred to nerve procedures (n=371 participants) (Table 1) (27-31, 33, 39, 43, 51, 65-72), 12 referred to tendon procedures (n=527) (Table 2) (21, 34, 53, 55-57, 59, 61, 62, 62, 63, 73) and four referred to mixed tendon and nerve procedures (n=112) (Table 3) (48,(74)(75)(76). There were only four comparative studies, one randomized controlled trial (comparing tibial nerve neurotomy with BTI) (65), and three parallel group studies on tendon procedures (21,56,59).…”

Efficacy and safety of acupuncture combined with rehabilitation in the treatment of strephenopodia after stroke

“… [3] Due to the irreversible damage of some high central nerves after stroke, the low central nerves lose effective regulation, cause hyperstretch reflex, present hemiplegia side muscle tone is abnormal, is the main reason that leads to limb motor dysfunction. [ 4 , 5 ] At the same time, relevant studies have shown [6] that the incidence of strephenopodia within 1 year after stroke is between 18% and 56%, which can lead to problems such as static and dynamic postural balance and walking. The main manifestations are increased tension of tibialis anterior muscle accompanied by varus, especially the muscle strength of peroneal short muscle is weakened, downward and inward twisting of affected side foot, varus angle greater than zero.…”