SURGERY OF THE EQUINUS DEFORMITY OF THE FOOT IN ADULT HEMIPLEGIA

The authors report the results of surgical treatment of the equinus de formity of the foot in adult hemiplegia performed on 23 patients with a long term follow-up for 20 of them. Surgical treatment required two phases. Firstly, a spasticity correction by scopiform neurotomy of the posterior tibial nerve: this operation had to be done 14 times becaus e of the importance of the spasticity. Secondly, a phase of truly orth opaedic surgery which involved successively, a treatment of the equinu s deformity by lengthening of the Achilleus tendon, a restoration of t he dorsal flexion by anterior muscle transfer and some complementary o perations on the forefoot. An astragalo-scaphoid arthrodesis was assoc iated in the 13 most recent cases. Results were subjectively judged ve ry good or good for 17 patients. Objectively, walking appliances have been reduced, gait was more secure and a greater autonomy has been rea ched. However, the goals of this surgery are limited as it has no inci dence on central interferent lesions and neuropsychological troubles r esulting from brain damage. The quality of the result is, in other res pects, conditional upon the gait pattern of the whole limb, particular ly upon the importance of the flexion of the knee during the step cycl e.