GAIT IN STROKE PATIENTS AFTER SELECTIVE TIBIAL NEUROTOMY

Background non purpose. - Spastic Fool may constitute a severe functio nal deficit leading to unstability in stance and unappropriate preposi tionning of the foot for its initial contact with the ground. The purp ose of the study was to analyze the results of selective tibial neurot omy on gait. Method. - After clinical examination of nine hemiplegic p atients, gait was recorded before surgery and six months after. Three- dimensional bilateral kinematic data were obtained with a motion measu rement system (VICON), and muscular electrical activity on affected si de was detected with surface electrodes. The patient walked barefoot, with his free velocity, on a ten meter track in the lab. An analogic v isual scale was used by the patient to evaluate gait discomfort. Resul ts. - After neurotomy, triceps surae spasticity decreased and passive motion of ankle increased. Gait comfort was better, claw toes and sore skin disappeared, Kinematics data were modified by neurotomy in all p atients. On the affected side, ankle dorsiflexion improved during stan ce for five patients and residual motricity improved during the swing phase for two patients, Stance knee hyperextension was corrected in th e five patients. EMG data: Selective tibial neurotomy caused disappear ance of triceps surae peak activity at the beginning of the stance pha se and at the end of swing phase. The time activity of the other muscl es did not change. Conclusion. - Selective tibial neurotomy can cure f oot deformity and modify ankle motion during gait. It corrects knee hy perextension during stance phase.