Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study

Mazzoli, Davide; Giannotti, E.; Rambelli, Chiara; Zerbinati, Paolo; Galletti, Martina; Mascioli, F.; Prati, P.; Merlo, Andrea

doi:10.1080/10749357.2019.1642651

Cited by 11 publications

(12 citation statements)

References 15 publications

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“…Six studies used the 10-Meter Walk Test (10MWT), and one study used the 6-Minute Walk Test (6MWT). Note that the 6MWT did not show any correlation with the functional scores achieved in this study ( 54 ). In one study, only the walking velocity was evaluated over 10 m ( 56 ).…”

Section: Resultscontrasting

confidence: 52%

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

l’Escalopier

Voisard²,

Michaud³

et al. 2022

Front. Neurol.

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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.

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Section: Resultscontrasting

confidence: 52%

“…The 6MWT does not appear to be a relevant indicator. As used in the study by Mazzoli et al ( 54 ), it shows no difference pre- and postoperatively, while all functional scores are improved. Its use is, therefore, not relevant in this indication.…”

Section: Discussionmentioning

confidence: 86%

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

l’Escalopier

Voisard²,

Michaud³

et al. 2022

Front. Neurol.

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“…32 Moreover, the importance of rehabilitation after surgery has recently been recognized as an indispensable and integral tool of the surgical approach as a whole, and to further improve the patients' quality of life. 17,18,33,34 Until now, the satisfaction rate of operated patients related to foot FS has never been investigated, except for a few articles that used to measure the overall quality of life, health, and gait through self-administered questionnaires. [17][18][19] The satisfaction rate was very high in this sample (78% of cases) and according to our analysis it was not directly related to functional walking ability, age of patient's first surgery, number of total surgical procedures, kind of surgical procedures, and type of disease.…”

Section: Discussionmentioning

confidence: 99%

Long‐term walking ability and patient satisfaction after lower limb functional surgery in patients affected by Charcot‐Marie‐Tooth disease: A retrospective study

Carantini¹,

Merlo²,

Esposito³

et al. 2020

J Peripheral Nervous Sys

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Structural foot deformities consequent to Charcot Marie Tooth (CMT) can be treated by functional surgery (FS). This study aims to evaluate both long‐term walking ability and patients' satisfaction in CMT subjects who underwent FS during their lifetime. We conducted a retrospective observational study. Age, sex, CMT type, comprehensive surgical history, current walking ability assessed by the Walking Handicap Scale (WHS) and patients' global impression of change (pGIC) were retrieved from a custom database managed at our institution. WHS and pGIC were assessed between mid‐2018 and mid‐2019. Data from 79 patients were screened and 63 were included, 35W‐28M, mean age 42 (15), with demyelinating (75%), axonal (20%), and other types (5%) of CMT, who underwent FS between 1967 and 2018. FS evolved significantly over the years from bone‐related procedures (e.g., arthrodesis) to both bone and soft tissues‐related procedures. The re‐intervention rate decreased from 70% before 2000 to 32% in the last decade. Complications arose in five cases. FS was mainly performed on adults (73%). WHS was ≥ 5 in three‐quarters of the sample (range 1‐6) and was significantly affected by age groups in patients with demyelinating CMT (n=47, p<0.01, non‐parametric ANOVA). Nearly 80% of patients were satisfied with FS (pGIC ≥ 4). In conclusion, CMT subjects who underwent FS surgery maintained a high gait efficiency in the long‐term period, with middle to high levels of satisfaction in the majority of the cases. This confirms the validity of FS in the management of acquired foot deformities in CMT patients.

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“…Surgical muscle lengthening is a common procedure used with neurological patients during neuro-orthopedic surgery in order to correct joint deviations (13)(14)(15). Two recent and independent studies on children affected by cerebral palsy (CP) have reported a significant decrease in muscle spasticity after muscle lengthening surgery (16,17).…”

Section: Introductionmentioning

confidence: 99%

Surgical quadriceps lengthening can reduce quadriceps spasticity in chronic stroke patients. A case-control study

Merlo¹,

Galletti²,

Zerbinati³

et al. 2022

Front. Neurol.

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BackgroundMuscle overactivity is one of the positive signs of upper motor neuron lesions. In these patients, the loss of muscle length and extensibility resulting from soft tissue rearrangement has been suggested as a contributing cause of muscle overactivity in response to stretching.ObjectiveTo assess the effects of surgical lengthening of the quadriceps femoris (QF) muscle-tendon unit by aponeurectomy on muscle spasticity.MethodsThis is a case-control study on chronic stroke patients with hemiparesis that have undergone lower limb functional surgery over a 8-year period. CASEs underwent corrective surgery for both the foot and knee deviations, inclusive of a QF aponeurectomy. Controls (CTRLs) underwent corrective surgery for foot deviations only. QF spasticity was assessed with the Modified Tardieu Scale (MTS) before and 1 month after surgery. The Wilcoxon test was used to assess MTS variations over time and the Mann–Whitney test was used to verify the presence of group differences at the 1 month mark.ResultsNinety-three patients were included: 57 cases (30F, 1–34 years from lesion) and 36 controls (12F, 1–35 years from lesion). Before surgery, both CASEs and CTRLs had similar MTS scores (median MTS = 3) and functional characteristics. One month after surgery, QF spasticity was significantly lower in the CASEs compared to CTRLs (p = 0.033) due to a significant reduction of the median MTS score from 3 to 0 in the CASE group (p < 0.001) and no variations in the CTRL group (p = 0.468). About half of the cases attained clinically significant MTS reductions and complete symptom relief even many years from the stroke.ConclusionsFunctional surgery inclusive of QF aponeurectomy can be effective in reducing or suppressing spasticity in chronic stroke patients. This is possibly a result of the reduction in neuromuscular spindle activation due to a decrease in muscle shortening, passive tension, and stiffness.

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Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study

Cited by 11 publications

References 15 publications

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

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

Long‐term walking ability and patient satisfaction after lower limb functional surgery in patients affected by Charcot‐Marie‐Tooth disease: A retrospective study

Surgical quadriceps lengthening can reduce quadriceps spasticity in chronic stroke patients. A case-control study

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