AUTHOR=Galletti Martina , Mazzoli Davide , Zerbinati Paolo , Rambelli Chiara , Basini Giacomo , Prati Paolo , Mascioli Francesca , Masiero Stefano , Merlo Andrea 

TITLE=Short-term reduction of ankle spasticity after surgical lengthening of the triceps surae in chronic post-stroke patients: a retrospective cohort study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1342777

DOI=10.3389/fneur.2024.1342777

ISSN=1664-2295

ABSTRACT=Introduction: In post-stroke patients with equinovarus foot deformity (EVFD), soft tissue rearrangements may contribute to muscle overactivity when tension or stretching is applied to a muscle. Therefore, we investigated the effects of surgically restoring the triceps surae (TS) length and lengthening ability on TS spasticity.
Methods: A retrospective study on chronic post-stroke patients who underwent neuro-orthopedic surgery inclusive of TS lengthening. TS spasticity was measured with the Modified Tardieu Scale (MTS) before, and one month after surgery, both with the knee extended (KE) and flexed (KF). MTS variations were analyzed with the Wilcoxon test. The time from stroke onset was compared between patients with and without post-surgical spasticity using the t-test. Statistical significance was set at 5%.
Results: 120 patients with EVFD, 57 (12) years, 1–36 years from stroke, were included. Median MTS_KE significantly decreased from 3 (range 0–4) to 2 (0–4) (p<0.001) after surgery. MTS decreased by ≥1 point in more than half of the sample. Notably, 19 and 32 patients were completely relieved from spasticity (MTS=0) in the KE and KF conditions, respectively. Post-surgical spasticity did not depend on the time since stroke onset (p=0.560).
Discussion: TS lengthening led to a short-term reduction of spasticity in 41% and 63% of chronic post-stroke patients for gastro-soleus and soleus respectively, and to a complete relief in 21% and 30% of the sample. Surgical lengthening can be considered an effective treatment that not only restores joint range of motion but also may reduce spasticity, even in chronic patients.