Le 02/12/2022 de 08:00 à 09:30

Retour Session


Revue systematique de litterature sur les criteres de choix des techniques chirurgicales de correction du pied equin-varus chez le sujet cerebrolese adulte.

Camille Cormier (Toulouse, France), Barbara Chan (Toulouse, France), Marianne Salib (Gonesse, France), Florence Faggianelli (Albi, France), Philippe Marque (Toulouse, France), Philippe Marque (Toulouse, France), David Gasq (Toulouse, France)

Objective : To report on preoperative outcomes that guide the selection of surgical techniques to correct equinovarus foot (EVF) in brain-injured adults.

Material / Patients and Methods : A search strategy was conducted on 4 databases (Pubmed, Medline, Cochrane, PEDro) until July, 2021, according to the PRISMA guidelines. Studies were included regardless of their level of evidence.

Results : Sixty-one studies (n=2,293 participants) were analyzed and concerned neurotomies (n=523), calf lengthening (n=437), tibialis anterior (TA) transfer (n=888) or alternative transfers with the flexor digitorum/hallucis longus (n=249), the extensor hallucis longus (n=102), the tibialis posterior (n=41), the peroneus longus (n=41) and osteoarticular surgeries (n=12). 
Passive ankle dorsiflexion was assessed before 87% of neurotomy studies, among which there was 62% of non-retracted spastic EVF. Ankle dorsiflexors motricity was assessed before 70% of neurotomies compared to 29% before isolated calf lengthening studies, their strength being at least 3/5 in respectively 33% and 50% of the studies concerned.
Before anterior tendon transfer with the TA or another muscle, passive ankle dorsiflexion was only reported in 20% and 46% of the studies and dynamic TA activation during gait in 46% and 56% of the studies, respectively.
The correction of varus justified the TA transfer in 60% of the studies, often independently of its function, compared to 30% in other transfers which were justified by hyperactivity or voluntary recruitment of transferred muscle.


Discussion - Conclusion : This work highlights the lack of formal data to rationally guide the choice of the most appropriate surgical technique in the management of EVF and reinforces the interest of a systematic standardized preoperative assessment.

Keywords : Foot Deformities, Acquired; Hemiplegia; Orthopedic Procedures; Tenotomy; Tendon Transfer; Neurosurgical Procedures.

Disclosure of interest : None