SELECTIVE NEUROTOMY OF THE TIBIAL NERVE IN THE SPASTIC HEMIPLEGIC CHILD - AN EXPLANATION OF THE RECURRENCE

A series including 13 unilateral selective tibial neurotomies for spas tic foot in hemiplegic children is reported. The results were consider ed excellent in three cases. Two cases needed additional corrective ca sts postoperatively. Eight cases had poor result with recurrence of th e same deformity. The authors conclude that the effect of tibial neuro tomy for spastic foot in hemiplegic children is transient in 61% of ca ses with a recurrence of the same deformity. Four of the patients with failed treatment underwent orthopedic surgery with muscle biopsies. H istologic data clearly demonstrate that previously denervated muscle f ibers were reinnervated carrying into extensive motor units. This find ing can explain the recurrence of the foot spasticity and deformity in neurotomized children.