Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Rehabilitation, Nijmegen, The Netherlands.
Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
J Neuroeng Rehabil. 2019 Aug 2;16(1):102. doi: 10.1186/s12984-019-0572-2.
Gait impairments are common and disabling in chronic stroke patients. Pes equinovarus deformity is one of the primary motor deficits underlying reduced gait capacity after stroke. It predisposes to stance-phase instability and subsequent ankle sprain or falls. This instability is most pronounced when walking barefoot. Tarsal fusion is a recommended treatment option for varus deformity, but scientific evidence is sparse. We therefore evaluated whether a tarsal fusion improved barefoot walking capacity in chronic stroke patients with pes equinovarus deformity.
Ten patients with a pes equinovarus deformity secondary to supratentorial stroke underwent surgical correction involving a tarsal fusion of one or more joints. Instrumented gait analysis was performed pre- and postoperatively using a repeated-measures design. Primary outcome measure was gait speed.
Walking speed significantly improved by 32% after surgery (0.38 m/s ± 0.20 to 0.50 m/s ± 0.17, p = 0.007). Significant improvement was also observed when looking at cadence (p = 0.028), stride length (p = 0.016), and paretic step length (p = 0.005). Step length on the nonparetic side did not change. Peak ankle moment increased significantly on the nonparetic side (p = 0.021), but not on the paretic side (p = 0.580). In addition, functional ambulation scores increased significantly (p = 0.008), as did satisfaction with gait performance (p = 0.017).
Tarsal fusion for equinovarus deformity in chronic stroke patients improves gait capacity, and the degree of improvement is of clinical relevance. Our results suggest that the improved gait capacity may be related to better prepositioning and loading of the paretic foot, leading to larger paretic step length and nonparetic ankle kinetics.
步态障碍在慢性脑卒中患者中很常见，且具有致残性。马蹄内翻足畸形是脑卒中后步态能力下降的主要运动缺陷之一。它会导致站立期不稳定，进而导致踝关节扭伤或跌倒。当患者赤脚行走时，这种不稳定性最为明显。距下关节融合术是治疗内翻畸形的推荐方法，但科学证据有限。因此，我们评估了距下关节融合术是否能改善脑卒中后伴有马蹄内翻足畸形的慢性脑卒中患者的赤脚行走能力。
10 名因幕上脑卒中导致马蹄内翻足畸形的患者接受了手术矫正，包括一个或多个关节的距下关节融合术。使用重复测量设计进行术前和术后的步态分析。主要的测量指标是步行速度。
手术后步行速度显著提高了 32%（0.38m/s±0.20 至 0.50m/s±0.17，p=0.007）。当观察步频（p=0.028）、步长（p=0.016）和患侧步长（p=0.005）时，也观察到了显著的改善。非患侧步长没有变化。非患侧的峰值踝关节力矩显著增加（p=0.021），但患侧没有变化（p=0.580）。此外，功能性步行能力评分显著提高（p=0.008），步态表现满意度也显著提高（p=0.017）。
慢性脑卒中患者的马蹄内翻足畸形行距下关节融合术可改善步态能力，且改善程度具有临床意义。我们的结果表明，步态能力的改善可能与患侧脚更好的前置和负荷有关，从而导致更大的患侧步长和非患侧踝关节动力学。
