Treatment of spastic equinovarus deformity in adult hemiplegia by fixationof the proximal extremity of the distal peroneus brevis tendon onto the tibialis anterior
G. Curvale et al., Treatment of spastic equinovarus deformity in adult hemiplegia by fixationof the proximal extremity of the distal peroneus brevis tendon onto the tibialis anterior, REV CHIR OR, 85(3), 1999, pp. 286-292
Citations number
23
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine
Journal title
REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L APPAREIL MOTEUR
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.