Tarsal fusion for pes equinovarus deformity improves gait capacity in chronic stroke patients

Autor: Jasper J. den Boer, Noël L.W. Keijsers, Maartje Kamps, Frits C. Lem, Alexander C. H. Geurts, Hanneke J. R. van Duijnhoven, Jan Willem K. Louwerens, Jorik Nonnekes
Rok vydání: 2019
Předmět:
Adult
Male
030506 rehabilitation
medicine.medical_specialty
Health Informatics
Barefoot
lcsh:RC321-571
03 medical and health sciences
Physical medicine and rehabilitation
All institutes and research themes of the Radboud University Medical Center
Deformity
Medicine
Humans
Stroke
Gait
lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry
Gait Disorders
Neurologic
Varus deformity
business.industry
Research
Rehabilitation
Tarsal fusion
Tarsal Bones
Middle Aged
medicine.disease
Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3]
Preferred walking speed
Equinovarus
Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10]
Clubfoot
medicine.anatomical_structure
Treatment Outcome
Gait analysis
Female
medicine.symptom
Ankle
0305 other medical science
business
human activities
Zdroj: Journal of Neuroengineering and Rehabilitation, 16
Journal of Neuroengineering and Rehabilitation, 16, 1
Journal of NeuroEngineering and Rehabilitation, Vol 16, Iss 1, Pp 1-6 (2019)
Journal of NeuroEngineering and Rehabilitation
ISSN: 1743-0003
Popis: Background 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. Methods 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. Results 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). Conclusions 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.
Databáze: OpenAIRE
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