Treatment of spastic equinovarus deformity in adult hemiplegia by fixationof the proximal extremity of the distal peroneus brevis tendon onto the tibialis anterior

Purpose of the study The purpose of the present study was to assess the Bardot procedure in the treatment of equinovarus deformities of the foot in spastic hemiplegia. Thi s procedure associates the fixation of the peroneus brevis distal tendon on to the tibialis anterior, heel-cord lengthening, and tenotomies of the flex ores digitorum. Material and methods Fifty-six patients underwent this procedure between 1989 and 1996. The indi cation for surgery was equinovarus deformity in adult spastic hemiplegia. P reoperatively all the patients had an instability and 80.5 per cent of them had to wear an ankle and foot orthesis. Postoperatively forty-one patients with a mean follow up of 3.5 years (rang e: one to 9 years), were available for examination including 24 females and 17 males with a mean age of 46 years at time of surgery (range: 27 to 76). Results All the patients were objectively improved. Seven of them had a discreet re sidual varus deformity, but none felt unstable. They all were able to walk barefooted, only one patient still required an adapted shoe. The gait and t he quality of live were subjectively improved for 92.7 per cent of the pati ents. None of the patients has been worsened. Discussion When spastic equinovarus disturbs significantly quality of live, tendon re- balancement of the hemiplegic foot should be proposed. The fixation of the distal tendon of the peroneus brevis onto the tibialis anterior is effectiv ely performed only if this latter is efficient in the swing phase of gait. If there is no fixed contracture, neurosurgery or chemotherapy are preferab le. In case of irreducible articular deformities arthrodesis could be indic ated. Conclusion Tendon re-balancement in hemiplegic foot using a peroneus tendon fixation o nto the tibialis anterior should be carried out after examination by a team of specialists (surgeon, neurosurgeon, rehabilitation team). In such condi tions it offers constantly an improvement to the patients.