Adult-onset hemiplegia: changes in gait after muscle-balancing procedures to correct the equinus deformity.

Fifty-four adult patients with acquired spastic equinus and equinovarus deformity were treated with lengthening of the Achilles tendon, lateral transfer of the anterior tibial tendon, and appropriate muscle releases. All patients had preoperative dynamic electromyography and electrogoniometry performed in order to assist in planning the surgical procedures and to provide a baseline assessment of the dynamic deformities. Preoperatively, the stance and double-support phases of gait were prolonged. Throughout the stance phase, the gait of these patients was characterized by equinus deformity of the ankle, decreased flexion of the knee (hyperextension in the most severely involved patients), and increased flexion of the hip (which also varied with the severity of the equinus deformity of the ankle and hyperextension of the knee). In all patients, the operation was performed at least one year after onset of the hemiplegia. Clinical follow-up at an average of thirty months (range, twenty-four to sixty-two months) showed that the equinus deformity was corrected in all patients and that 59 per cent of them were brace-free. Two patients had a superficial infection that healed uneventfully, and two had pull-out of the tendon that required reoperation. Postoperative analyses of gait, performed at least one year after surgery for twenty-seven of the patients, showed that the stance and double-support phases of gait (which had been prolonged before surgery) approached the findings in normal control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)