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Effects of Diagnostic Tibial Nerve Block and Selective Tibial Nerve Neurotomy on paresis angle and spasticity angle of the ankle: a retrospective observational study

Lamora, Jean-Philippe
(2020)

Files

LAMORA_JeanPhilippe_82281800_2019-2020.pdf
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Details

Supervisors
Deltombe, Thierry ; Gustin, Thierry
Faculty
Faculté des sciences de la motricité
Degree label
Master [120] en sciences de la motricité, orientation générale
Abstract
Objectives: To assess the effects of diagnostic nerve block (DNB) and selective tibial nerve neurotomy (STN) on passive and active ankle dorsiflexion in spastic patients. Methods: We retrospectively studied 317 patients with a spastic equinovarus foot (SEF) who underwent a DNB and were then treated by STN between August 1997 and April 2019. Two groups were constituted. The first group (n = 46) had active and passive assessments before and after DNB and within 6 months after STN. The second group (n = 24) had a second assessment beyond 6 months after STN. Primary outcome: paresis angle Z (difference between maximal passive (XV1) and active (XVA) ankle dorsiflexion range of motion). Secondary outcomes: spasticity angle X (difference between XV1 and angle of catch (XV3)), variations in Ashworth and Tardieu scales and medical research council (MRC) scale. Results: XVA and paresis angle Z increased after DNB and STN in both knee positions except at long-term with the knee in extended position. XV1 increased after STN but returned close to baseline at long term. Spasticity angle X, angle of catch XV3 and Ashworth and Tardieu scores were permanently improved. MRC score was unchanged for tibialis anterior and triceps surae after STN. Conclusion: STN improves ankle active dorsiflexion. We may therefore postulate that STN induces a long-lasting reduction of spastic co-contractions of the foot. DNB is a good predictor of this result.