Mikio Muraoka1,2*, Koshiro Imai2, Shin Watanabe2 and Yasuharu Kinjo2
1Department of Rehabilitation Medicine, Kameda-Daiichi Hospital, Niigata, Japan
2Department of Orthopedic Surgery, Kameda-Daiichi Hospital, Niigata, Japan
*Corresponding Author: Mikio Muraoka, Department of Rehabilitation Medicine, Kameda-Daiichi Hospital, Niigata, Japan.
Received: February 07, 2022; Published: February 24, 2022
Objective: Surgical corrections are effective for severe spastic equinovarus deformities, but postoperative problems may occur over time. The present study examined postoperative problems and differentiated the proper surgical procedures.
Materials and Methods: We studied 12 feet of 11 patients with severe equinovarus deformities resulting from stroke or brain injury that were corrected surgically. Achilles tendons elongation after Z-plasty (n = 7) or fractional tendinous elongation (n = 5) was performed. Tendon transfers were performed using the tibialis anterior (TA) (n = 7) or tibialis posterior (TP) (n = 5) tendon. Flexor hallucis longus (FHL), flexor digitorum longus (FDL), or flexor digitorum brevis (FDB) tendons were released or elongated for 9 feet with curling toes.
Results: Pes calcaneus deformities occurred postoperatively in 4 feet undergoing a combination of Achilles tendon Z-plasty and TP tendon transfer, and required revision surgery. Of the 9 feet with curling toes, 4 underwent flexor elongations for curling toes, and 3 of these required flexor tenotomies or additional elongations; 5 feet in which the flexor tendons were released required no further surgery.
Conclusion: Achilles tendon elongation following Z plasty often causes overcorrection of pes calcaneus when the transferred TP tendon works too strongly. In contrast, overcorrection does not seem to occur when fractional tendinous elongation of Achilles tendon and TA tendon transfer are combined. Surgeons should consider whether elongations for curling toes are appropriate to perform during the first surgery because subsequent operations are often required.
Keywords: Equinovarus; Curling Toe; Stroke; Brain Injury; Spasticity; Surgery
Citation: Mikio Muraoka., et al. “Postoperative Problems Following Surgical Corrections for Spastic Equinovarus Deformities”.Acta Scientific Medical Sciences 6.3 (2022): 117-122.
Copyright: © 2022 Mikio Muraoka., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.