MANAGEMENT OF THE ADULT, SPASTIC, EQUINOVARUS FOOT DEFORMITY

Management of the persistent, acquired, neurogenic equinovarus foot ma y be a confounding rehabilitative dilemma. Victims of cerebrovascular accidents and traumatic brain injury commonly develop this neurogenic deformity. The plantarflexed and inverted foot position results from a n imbalance of forces about the hindfoot due to exaggerated muscle ton e and hyperactive stretch reflexes. Significant functional impairment may ensue if a plantigrade foot position cannot be achieved and mainta ined. Surgical correction may be necessary if conservative measures fa il. Determination of the dynamic and static components contributing to the equinovarus deformity is difficult. Gait analysis and dynamic ele ctromyographic studies are valuable adjuncts for operative planning. T he wide-ranging goals of surgery vary from improving transfer and ambu lation skills, to assisting wheelchair positioning, to facilitating us e of braces and/or shoe wear.