ASSESSMENT AND TREATMENT OF SPASTIC EQUINOVARUS FOOT AFTER STROKE: GUIDANCE FROM THE MONT-GODINNE INTERDISCIPLINARY GROUP

作者：Deltombe Thierry^*; Wautier Delphine; De Cloedt Philippe; Fostier Michele; Gustin Thierry

来源：Journal of Rehabilitation Medicine, 2017, 49(6): 461-468.

DOI：10.2340/16501977-2226

• stroke
• muscle spasticity
• foot
• guidance

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.

• 出版日期2017-6