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

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1042667

DOI=10.3389/fneur.2022.1042667

ISSN=1664-2295

ABSTRACT=Introduction: The aim of this study is 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 gestures, 19 studies (58%) evaluated tendon transfer gestures, and only two studies (6%) evaluated the combination of tendon and neurological gestures. Instrumental gait analysis was performed in only 11 studies (33%), and only six studies (18%) combined it with clinical and functional analyses. Clinicals 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.