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ORIGINAL ARTICLE   Free accessfree

European Journal of Physical and Rehabilitation Medicine 2019 April;55(2):169-75

DOI: 10.23736/S1973-9087.18.05290-5


language: English

Safety and long-term effects on gait of hemiplegic patients in equinovarus foot deformity surgical correction followed by immediate rehabilitation: a prospective observational study

Erika GIANNOTTI 1, 2, Andrea MERLO 1 , Paolo ZERBINATI 1, 3, Paolo PRATI 1, Stefano MASIERO 2, Davide MAZZOLI 1

1 Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy; 2 Unit of Rehabilitation, Department of Neuroscience, University of Padua, Padua, Italy; 3 Neuro-orthopedic Service, MultiMedica Castellanza Hospital, Castellanza, Varese, Italy

BACKGROUND: 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.
AIM: To determine long-term safety and efficacy of functional surgery followed by early rehabilitation (FSER).
DESIGN: A 12 months prospective observational study.
SETTING: Outpatients clinic, Gait and Motion Laboratory, Sol et Salus Hospital, Rimini, Italy.
POPULATION: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
CLINICAL REHABILITATION IMPACT: FSER can be considered an encouraging approach in the management of EVFD, with durable results.

KEY WORDS: Stroke; Surgical procedures, operative; Equinus deformity; Gait; Rehabilitation

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