Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy.
Unit of Rehabilitation, Department of Neuroscience, University of Padua, Padua, Italy.
Eur J Phys Rehabil Med. 2019 Apr;55(2):169-175. doi: 10.23736/S1973-9087.18.05290-5. Epub 2018 Aug 27.
Equinovarus foot deformity (EVFD) is the most common lower limb deformity in stroke patients. Immobilization following EVFD surgical correction is known to have a negative impact on muscle rearrangement with possible loss of walking ability in stroke patients. In a previous study, safe and positive effects at one-month follow-up after surgery were obtained with an early rehabilitation treatment (ERT) characterized by immediate walking and training.
To determine long-term safety and efficacy of functional surgery followed by early rehabilitation (FSER).
A 12 months prospective observational study.
Outpatients clinic, Gait and Motion Laboratory, Sol et Salus Hospital, Rimini, Italy.
Twenty-four adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55±13 years, affected side 12L/12R, time from lesion 5±4 years.
Patients received clinical and instrumental evaluation by gait analysis (GA) before (T0), one, three and twelve months after surgery. Safety was defined as the absence of any complication consequent to FSER. Efficacy was assessed by the recovery in ankle kinematics, walking speed and space-time parameters.
No clinical complication (thrombosis, surgical wound infection, muscle or tendon injury, muscle hematoma) arose in the sample during the follow-up year. Variables relating to ankle kinematics improved towards their normal values at one month after surgery. These were maintained at 3 and 12 months, with a significant difference between follow-ups and pre-surgical values (Durbin-Conover Test, P<0.01). Gait speed, cadence, anterior step length and stride length of the affected side showed a statistical improvement at 3 and 12 months (Wilcoxon test, P=0.012 and P=0.001, respectively). Stride width decreased at 1 month after surgery and showed a further stable reduction at 3 months (P=0.008).
The ERT protocol with immediate rehabilitation starting on the first day after surgical correction was safe and effective in providing a long-term correction of EVFD. Ankle dorsiflexion improved both in stance and swing, allowing for a significative improvement in walking speed.
FSER can be considered an encouraging approach in the management of EVFD, with durable results.
马蹄内翻足畸形（EVFD）是中风患者最常见的下肢畸形。EVFD 手术后的固定会对肌肉重新排列产生负面影响，可能导致中风患者丧失行走能力。在之前的一项研究中，通过立即行走和训练为特征的早期康复治疗（ERT），在手术后一个月的随访中获得了安全和积极的效果。
确定功能手术（FSER）后进行早期康复治疗的长期安全性和疗效。
12 个月前瞻性观察研究。
意大利里米尼 Sol et Salus 医院门诊、步态与运动实验室。
24 名接受 EVFD 手术矫正并接受 ERT 的成年慢性中风幸存者，年龄 55±13 岁，患侧 12L/12R，发病时间 5±4 年。
患者在手术前（T0）、手术后 1、3 和 12 个月接受临床和仪器评估，包括步态分析（GA）。安全性定义为 FSER 无任何并发症。通过踝关节运动学、行走速度和时空参数的恢复来评估疗效。
在随访期间，样本中没有发生任何与 FSER 相关的临床并发症（血栓形成、手术伤口感染、肌肉或肌腱损伤、肌肉血肿）。踝关节运动学相关变量在手术后一个月向正常值恢复。这些在 3 个月和 12 个月时保持不变，与术前值相比有显著差异（杜宾-康纳检验，P<0.01）。患侧的行走速度、步频、前步长和步长在 3 个月和 12 个月时均有统计学改善（威尔科克森检验，P=0.012 和 P=0.001）。步宽在手术后 1 个月减小，3 个月时进一步稳定减小（P=0.008）。
在手术矫正后立即开始康复的 ERT 方案在提供 EVFD 的长期矫正方面是安全有效的。踝关节背屈在站立和摆动期均得到改善，从而显著提高了行走速度。
FSER 可被视为 EVFD 治疗的一种有前途的方法，具有持久的效果。
