Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review

Abstract

ObjectiveEquinus foot deformity (EFD) is the most common deformity following a stroke. Several approaches have been suggested for its correction, including pharmacological, surgical, and physical therapy (PT) interventions. This scoping review aims to map and synthesize the available evidence focusing on physical therapy treatments for EFD caused by triceps surae (TS) spasticity.MethodsScoping review methodological frameworks have been used. Pubmed, Cinahl, and Cochrane databases were searched for primary literature. Studies focusing on the treatment of EFD in adult stroke patients were included only when the intervention involved PT treatments and presented at least one outcome measure for the functional and/or structural condition of the TS. Data were systematically collected and reported in tables inclusive of type of intervention, sample characteristics, dosage, comparators, outcomes, follow-up timeline, and treatment efficacy. A narrative synthesis was also added.ResultsOf the 642 experimental or observational screened studies, 53 were included, focusing on stretching exercises, shock waves, electrical stimulation, dry needling, TENS, vibration therapy, ultrasounds, cryotherapy, and active physiotherapy. Patients with EFD benefited from specific physical therapy treatments. These usually resulted in Modified Ashworth Scale reduction, typically by 1 point, and an increase in ROM. Interventions consisting of shock waves, dry needling, and electrostimulation showed the best results in reducing EFD. Heterogeneous dosage and delivery mode generally limited conclusions.ConclusionsThis scoping review summarized available primary literature based on PT treatments for the correction of EFD. By highlighting the remaining gaps in knowledge, it provides a reference for future studies on this pathology. Further investigations are necessary to pinpoint the best dosage and delivery methods. Future studies should investigate whether early rehabilitation programs started during the acute phase might help prevent or limit the development of secondary deformities.

Short-term reduction of ankle spasticity after surgical lengthening of the triceps surae in chronic post-stroke patients: a retrospective cohort study

“…We attempted to compensate for this shortcoming by obtaining a large sample size. Future trials may compare the effects of surgical lengthening to other treatments aimed at reducing soft tissue stiffness, such as stretching, shock waves, or dry needling ( 12 ).…”

“…We attempted to compensate for this shortcoming by obtaining a large sample size. Future trials may compare the effects of surgical lengthening to other treatments aimed at reducing soft tissue stiffness, such as stretching, shock waves, or dry needling (12). The absence of long-term data represents another limitation of the current study that limits the clinical applicability of our findings.…”

“…EVFD treatments in post-stroke patients with triceps spasticity are manifold. These treatments include focal muscle blockage by botulinum toxin injections (9,10) or chemical neurolysis with phenol or alcohol (11), physical therapy interventions (12), orthotic interventions (13,14), and neuro-orthopedic surgery (15)(16)(17)(18). Different surgical approaches have been developed targeting the calf muscles of patients with EVFD.…”

Outcome measures for assessing the effectiveness of physiotherapy interventions on equinus foot deformity in post-stroke patients with triceps surae spasticity: A scoping review

“…On the one hand, some of these treatments, such as shock waves, dry needling, and electrical stimulation, showed similar promising results. On the other hand, when analyzing these studies, at least two weak points can be identified [ 14 ]. Firstly, the countless modalities used for the assessment of spasticity in EVFD prevent direct comparisons of the results.…”

“…Recent studies have focused on many PT treatments of triceps surae (TS) spasticity following stroke [5,8,[10][11][12][13][14]. These include stretching, shock waves, electrostimulation, dry-needling, transcutaneous electrical nerve stimulation, vibrations, ultrasound, cryotherapy, and physiotherapist-guided physical exercising.…”