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- Title
ASSESSMENT AND TREATMENT OF SPASTIC EQUINOVARUS FOOT AFTER STROKE: GUIDANCE FROM THE MONT-GODINNE INTERDISCIPLINARY GROUP.
- Authors
DELTOMBE, Thierry; WAUTIER, Delphine; DE CLOEDT, Philippe; FOSTIER, Michèle; GUSTIN, Thierry
- Abstract
Objective: To present interdisciplinary practical guidance for the assessment and treatment of spastic equinovarus foot after stroke. Results: Clinical examination and diagnostic nerve block with anaesthetics determine the relative role of the factors leading to spastic equinovarus foot after stroke: calf spasticity, triceps surae - Achilles tendon complex shortening and dorsiflexor muscles weakness and/or imbalance. Diagnostic nerve block is a mandatory step in determining the cause(s) of, and the most appropriate treatment(s) for, spastic equinovarus foot. Based on interdisciplinary discussion, and according to a patient-oriented goal approach, a medical and/or surgical treatment plan is proposed in association with a rehabilitation programme. Spasticity is treated with botulinum toxin or phenol--alcohol chemodenervation and neurotomy, shortening is treated by stretching and muscle- tendon lengthening, and weakness is treated by ankle-foot orthosis, functional electrical stimulation and tendon transfer. These treatments are frequently combined. Conclusion: Based on 20 years of interdisciplinary expertise of management of the spastic foot, guidance was established to clarify a complex problem in order to help clinicians treat spastic equinovarus foot. This work should be the first step in a more global international consensus.
- Subjects
BOTULINUM toxin; THERAPEUTICS; SPASTICITY diagnosis; TIBIAL nerve surgery; PHENOLS; TREATMENT of foot abnormalities; ETHANOL; DIFFERENTIAL diagnosis; NERVE block; SPASTICITY; STROKE; DISEASE complications
- Publication
Journal of Rehabilitation Medicine (Stiftelsen Rehabiliteringsinformation), 2017, Vol 49, Issue 6, p461
- ISSN
1650-1977
- Publication type
Article
- DOI
10.2340/16501977-2226