BACKGROUND Gait impairments are common and disabling in chronic stroke patients. Pes equinovarus deformity is one of the primary motor deficits underlying reduced gait capacity after stroke. It predisposes to stance-phase instability and subsequent ankle sprain or falls. This instability is most pronounced when walking barefoot. Tarsal fusion is a recommended treatment option for varus deformity, but scientific evidence is sparse. We therefore evaluated whether a tarsal fusion improved barefoot walking capacity in chronic stroke patients with pes equinovarus deformity. METHODS Ten patients with a pes equinovarus deformity secondary to supratentorial stroke underwent surgical correction involving a tarsal fusion of one or more joints. Instrumented gait analysis was performed pre- and postoperatively using a repeated-measures design. Primary outcome measure was gait speed. RESULTS Walking speed significantly improved by 32% after surgery (0.38 m/s ± 0.20 to 0.50 m/s ± 0.17, p = 0.007). Significant improvement was also observed when looking at cadence (p = 0.028), stride length (p = 0.016), and paretic step length (p = 0.005). Step length on the nonparetic side did not change. Peak ankle moment increased significantly on the nonparetic side (p = 0.021), but not on the paretic side (p = 0.580). In addition, functional ambulation scores increased significantly (p = 0.008), as did satisfaction with gait performance (p = 0.017). CONCLUSIONS Tarsal fusion for equinovarus deformity in chronic stroke patients improves gait capacity, and the degree of improvement is of clinical relevance. Our results suggest that the improved gait capacity may be related to better prepositioning and loading of the paretic foot, leading to larger paretic step length and nonparetic ankle kinetics.

中文翻译：

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睑板融合术治疗pes equnovanovarus畸形可改善慢性中风患者的步态能力。

背景技术在慢性中风患者中，步态障碍是常见的并且是残疾的。Pes equinovarus畸形是中风后步态能力下降的主要运动缺陷之一。它倾向于站姿不稳以及随后的脚踝扭伤或跌倒。赤脚行走时，这种不稳定性最明显。s骨融合术是内翻畸形的推荐治疗方法，但科学证据稀少。因此，我们评估了睑板融合术是否改善了患有等腰椎畸形的慢性卒中患者的赤脚行走能力。方法对10例因幕上中风继发的等腰索畸形患者进行了手术矫正，其中涉及一个或多个关节的骨融合。术前和术后采用重复测量设计进行仪器化步态分析。主要结局指标是步态速度。结果手术后步行速度显着提高了32％（0.38 m / s±0.20至0.50 m / s±0.17，p = 0.007）。观察节奏（p = 0.028），步幅（p = 0.016）和步距（p = 0.005）时，也观察到显着改善。非参数侧的步长不变。非paretic一侧的峰值踝力矩明显增加（p = 0.021），而paretic一侧的峰值踝力矩则没有明显增加（p = 0.580）。此外，功能性步态得分显着提高（p = 0.008），对步态表现的满意程度（p = 0.017）。结论s骨融合治疗慢性卒中患者的等位畸形可改善步态能力，其改善程度与临床相关。