Claw toes in hemiplegic patients after stroke.

OBJECTIVE

The aim of this study was to analyze the prevalence of claw toes and its correlation to other lower limb disorders as well as the global functional recovery in a population of hemiplegic patients 1year post-stroke.

PATIENTS AND METHODS

This prospective study included 39 stroke patients hospitalized in the Physical Medicine and Rehabilitation (PM&R) department of a hospital between September2000 and September2001. The evaluation looked for incidence of claw toes during the first year post-stroke and whether there was a potential link to triceps surae spasticity, motor impairment of the leg and patients' functional abilities (Barthel Index, postural assessment scale for stroke patients [PASS], functional ambulation classification [FAC]).

RESULTS

We conducted a total of 64 evaluations (one to four by patient). In 18 out of 39 (46%) patients, we found an occurrence of claw toes. In 15 out of 18 (83%) patients, who regained average functional capacities, its onset took place before the end of the third month post-stroke (Barthel: 30-70, PASS: 15-33, FAC: 3-4) and it was significantly linked to equinus and/or varus foot (p<0.0001).

CONCLUSION

The occurrence of claw toes in hemiplegic patients is common and happens early on post-stroke. Equinus and/or varus foot and average functional capacities were associated to claw toes. Despite the few studies devoted to this condition in stroke patients, this condition must be diagnosed early and taken into account to improve the patient's rehabilitation care.