Effects of tibial nerve neurotomy on posture and gait in stroke patients: A focus on patient-perceived benefits in daily life

• Published in: Journal of the neurological sciences 2016-07, Vol.366, p.158-163
• Main Authors: Le Bocq, Charlotte, Rousseaux, Marc, Buisset, Nadia, Daveluy, Walter, Blond, Serge, Allart, Etienne
• Format: Article
• Language: English
• Subjects: Accidental Falls; Activities of Daily Living; Biomechanical Phenomena; Equinovarus foot; Female; Gait; Gait - physiology; Humans; Leg - physiopathology; Male; Middle Aged; Muscle Spasticity - etiology; Muscle Spasticity - physiopathology; Muscle Spasticity - psychology; Muscle Spasticity - surgery; Muscle Strength; Muscle, Skeletal - physiopathology; Neurology; Neurotomy; Outpatients; Posture; Posture - physiology; Prospective Studies; Range of Motion, Articular; Spasticity; Stroke; Stroke - physiopathology; Stroke - psychology; Stroke - surgery; Stroke Rehabilitation - methods; Tibial Nerve - surgery; Treatment Outcome
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2016.04.055

Abstract Objective. To evaluate the objective and subjective functional effectiveness of tibial nerve neurotomy (TNN) in post-stroke spastic equinovarus foot (SEF). Methods In an open study, 23 hemiplegic patients were assessed immediately before TNN and then 5 months after TNN. The main outcome measure was the Lower Limb Function Assessment Scale (LL-FAS), which provided an ecologic assessment of impairments in standing and walking (i.e. kinematic abnormalities) and their impacts on activities of daily living. Patients were also assessed for global clinical impression of change, fear of falling, neuromotor impairments, spatiotemporal and video gait parameters and walking capacities. Results TNN had a very marked effect on the level of spasticity and the range of motion in dorsiflexion (p 〈10 − 3 ). These changes resulted in better foot positioning when standing and walking (particularly in stance), which was perceived very favorably by the patients. There was a clear, patient-perceived improvement in activities performed when standing and walking (LL-FAS ( p < 0.01)), the global clinical impression of change ( p < 10 − 3 ) and the fear of falling ( p = 0.022) that was not revealed by conventional, objective measurements (New Functional Ambulation Classification, Rivermead Mobility Index). Conclusion TNN is an effective treatment for post-stroke SEF; it is associated with a patient-reported improvement in standing and walking abilities during activities of daily living. Further research must now assess the long-term subjective efficacy of TNN.