Efficacy of the selective neurotomy in the treatment of the spastic equinovarus foot among adult stroke patients following the ICF model. A randomized, single-blind, controlled trial

Purpose.- To demonstrate the efficacy of the selective neurotomy in treating spastic equinovarus foot (SEF) in adult stroke patients. Material and methods.- Sixteen chronic stroke patients were recruited and randomised in two groups: eight patients underwent a tibial neurotomy, the eight others received botulinum toxin injections in the calf muscles. Body structures and functions (MAS, Tardieu scale, L-path, MRC scale, passive ROM, instrumented gait analysis), activities (ABILOCO), participation (SATIS-Stroke) and quality of life (SF-36) were evaluated in both groups by a blind assessor before, 2 months and 6 months after treatment. Results.- In comparison with botulinumtoxin injections, tibial nerve neurotomy induced a higher reduction in spasticity and a more significant decrease in total viscoelastic stiffness of the ankle. Both treatments induced a comparable improvement of ankle kinematics during gait, while none of them induced a significant muscle weakening. Activities, participation and quality of life were not significantly modified in both groups. Discussion.- SEF is a major cause of disability for stroke patients, impairing their daily living activities, social participation and quality of life. When this deformity is primarily due to muscle overactivity, various focal treatments including selective neurotomy can be proposed together with the rehabilitation program. This neurosurgical procedure consists of a partial and selective section of the motor nerve branches that innervate spastic muscles. For a low cost, it can permanently reduce muscle overactivity. However, its effectiveness had only been suggested through uncontrolled case series studies [1], mainly focussing on body structures and functions. The present study demonstrates with a high level of scientific evidence that tibial nerve neurotomy is an efficient treatment of SEF, reducing impairments of chronic stroke patients. Future studies should still be conducted in order to confirm the long-term efficacy of this treatment following the International Classification of Functioning, Disability and Health (ICF).