Thierry Deltombe, Delphine Wautier, Philippe De Cloedt, Michèle Fostier, Thierry Gustin
Physical Medicine and Rehabilitation Department, Université catholique de Louvain, Cliniques universitaires de Mont-Godinne, , BE-5530 Yvoir, Belgium. E-mail: thierry.deltombe@uclouvain.be
DOI: 10.2340/16501977-2226

Objective: To present interdisciplinary practical guidance for the assessment and treatment of spastic equinovarus foot after stroke.
Results: Clinical examination and diagnostic nerve block with anaesthetics determine the relative role of the factors leading to spastic equinovarus foot after stroke: calf spasticity, triceps surae - Achilles tendon complex shortening and dorsiflexor muscles weakness and/or imbalance. Diagnostic nerve block is a mandatory step in determining the cause(s) of, and the most appropriate treatment(s) for, spastic equinovarus foot. Based on interdisciplinary discussion, and according to a patient-oriented goal approach, a medical and/or surgical treatment plan is proposed in association with a rehabilitation programme. Spasticity is treated with botulinum toxin or phenol–alcohol chemodenervation and neurotomy, shortening is treated by stretching and muscle-tendon lengthening, and weakness is treated by ankle-foot orthosis, functional electrical stimulation and tendon transfer. These treatments are frequently combined.
Conclusion: Based on 20 years of interdisciplinary expertise of management of the spastic foot, guidance was established to clarify a complex problem in order to help clinicians treat spastic equinovarus foot. This work should be the first step in a more global international consensus.

After a stroke, patients frequently suffer from a deformed foot (so called spastic equinovarus foot) affecting their gait and mobility. Based on a 20 years interdisciplinary expertise, we present a practical guidance for the assessment and treatment of the spastic foot after stroke. The causes of the deformity vary from one patient to another. The clinical examination and transient spasticity reduction thanks to nerve blockade allows to determine the exact cause(s) and the most appropriate treatment(s). Based on a patient-centered approach, the treatments include rehabilitation, orthosis, chemodenervation, nerve and tendon surgery rehabilitation, orthosis, chemodenervation, nerve and tendon surgery. We hope this guidance will help colleagues to treat their patients suffering from spastic equinovarus foot after stroke