[The development of gait in the hemiplegic patient after selective tibial neurotomy].

BACKGROUND AND PURPOSE

Spastic Foot may constitute a severe functional deficit leading to instability in stance and inappropriate prepositioning of the foot for its initial contact with the ground. The purpose of the study was to analyze the results of selective tibial neurotomy on gait.

METHOD

After clinical examination of nine hemiplegic patients, gait was recorded before surgery and six months after. Three-dimensional bilateral kinematic data were obtained with a motion measurement system (VICON), and muscular electrical activity on affected side was detected with surface electrodes. The patient walked barefoot, with his free velocity, on a ten meter track in the lab. An analogic visual scale was used by the patient to evaluate gait discomfort.

RESULTS

After neurotomy, triceps surae spasticity decreased and passive motion of ankle increased. Gait comfort was better, claw toes and sore skin disappeared. Kinematics data were modified by neurotomy in all patients. On the affected side, ankle dorsiflexion improved during stance for five patients and residual motricity improved during the swing phase for two patients. Stance knee hyperextension was corrected in the five patients. EMG data: Selective tibial neurotomy caused disappearance of triceps surae peak activity at the beginning of the stance phase and at the end of swing phase. The time activity of the other muscles did not change.

CONCLUSION

Selective tibial neurotomy can cure foot deformity and modify ankle motion during gait. It corrects knee hyperextension during stance phase.