Improvement of gait in a stroke patient. A 7-year longitudinal study

Purpose. To report on the gait improvement obtained in a stroke patient after applying three treatments for spastic equinus varus foot: botulinum toxin injection (BTI), tibial nerve neurotomy (TNN), and orthopaedic surgery (triple arthrodesis), during a 7-year longitudinal follow-up period. Method. A quantified analysis of a stroke patient's gait was performed on a Gaitrite (R) walking mat before and after applying BTI 3 years, TNN 4 years and orthopaedic surgery 7 years after the stroke. Results. After the three treatments, the spasticity disappeared, the range of ankle motion improved and voluntary command of the tibialis anterior became possible. Upon comparing the gait parameters before treatment and after the three treatments, it was observed that the comfortable gait velocity had increased (from 0.42 m/s to 0.70 m/s), the step length had become more symmetrical (from left 19 cm, right 57 cm to left 50 cm, right 51 cm), the step width had decreased (from 23 cm to 12 cm). In terms of participation, walking barefoot had become possible without a cane, as well as going up and down stairs and walking outdoors on uneven ground without any help. Conclusions. Stroke patients during the chronic phase with a spastic equinovarus deformity can benefit from various commonly used therapeutic interventions. BTI and TNN were found to be efficient but only for a short time. Orthopaedic surgery gave the most long-lasting results. Further studies should be performed on a larger number of patients to determine the most suitable options for treating stroke patients with an equinus varus foot.