Evaluation methods to assess the efficacy of equinovarus foot surgery on the gait of post-stroke hemiplegic patients: A literature review

Nicolas de l'Escalopier; Cyril Voisard; Mona Michaud; Albane Moreau; Sylvain Jung; Brian Tervil; Nicolas Vayatis; Laurent Oudre; Damien Ricard

doi:10.3389/fneur.2022.1042667

Evaluation methods to assess the efficacy of equinovarus foot surgery on the gait of post-stroke hemiplegic patients: A literature review

Front Neurol. 2022 Nov 9:13:1042667. doi: 10.3389/fneur.2022.1042667. eCollection 2022.

Authors

Nicolas de l'Escalopier^{1

2}, Cyril Voisard^{1

3}, Mona Michaud^{1

4}, Albane Moreau^{1

3}, Sylvain Jung^{5

6

7}, Brian Tervil⁵, Nicolas Vayatis⁵, Laurent Oudre⁵, Damien Ricard^{1

3

8}

Affiliations

¹ Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, CNRS, SSA, INSERM, Centre Borelli, Paris, France.
² Service de Chirurgie Orthopédique, Traumatologie et Réparatrice des Membres, Service de Santé des Armées, HIA Percy, Clamart, France.
³ Service de Neurologie, Service de Santé des Armées, HIA Percy, Clamart, France.
⁴ SYSNAV, Vernon, France.
⁵ Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, CNRS, SSA, INSERM, Centre Borelli, Gif-sur-Yvette, France.
⁶ Universitꃩ Sorbonne Paris Nord, L2TI, UR 3043, Villetaneuse, France.
⁷ ENGIE Lab CRIGEN, Stains, France.
⁸ Ecole du Val-de-Grãâce, Service de Santé des Armées, Paris, France.

Abstract

Introduction: The aim of this study was to realize a systematic review of the different ways, both clinical and instrumental, used to evaluate the effects of the surgical correction of an equinovarus foot (EVF) deformity in post-stroke patients.

Methods: A systematic search of full-length articles published from 1965 to June 2021 was performed in PubMed, Embase, CINAHL, Cochrane, and CIRRIE. The identified studies were analyzed to determine and to evaluate the outcomes, the clinical criteria, and the ways used to analyze the impact of surgery on gait pattern, instrumental, or not.

Results: A total of 33 studies were included. The lack of methodological quality of the studies and their heterogeneity did not allow for a valid meta-analysis. In all, 17 of the 33 studies involved exclusively stroke patients. Ten of the 33 studies (30%) evaluated only neurotomies, one study (3%) evaluated only tendon lengthening procedures, 19 studies (58%) evaluated tendon transfer procedures, and only two studies (6%) evaluated the combination of tendon and neurological procedures. Instrumental gait analysis was performed in only 11 studies (33%), and only six studies (18%) combined it with clinical and functional analyses. Clinical results show that surgical procedures are safe and effective. A wide variety of different scales have been used, most of which have already been validated in other indications.

Discussion: Neuro-orthopedic surgery for post-stroke EVF is becoming better defined. However, the method of outcome assessment is not yet well established. The complexity in the evaluation of the gait of patients with EVF, and therefore the analysis of the effectiveness of the surgical management performed, requires the integration of a patient-centered functional dimension, and a reliable and reproducible quantified gait analysis, which is routinely usable clinically if possible.

Keywords: IMU; equinovarus foot; gait analysis; hemiplegia; neuro-orthopedic surgery; stroke.

Publication types

Systematic Review