Equinovarus foot function after stroke

Rationale: Equinovarus is the most frequently seen foot deformity in the affected leg after stroke and compromises the patient’s walking ability and participation in daily life. Surgical intervention is a promising therapy since it enables the patient to walk more independently, barefoot, without the need of an orthosis. However, the effects of the foot and ankle surgery on restoring foot and ankle kinematics and kinetics, walking ability and on quality of life are not or not extensively studied.

Objective: The aims of this study are to explore the effects of foot and ankle surgery on the equinovarus foot deformity of patients after stroke in terms of foot function, walking abilities and social participation.

Study design: This study has an exploratory design with two measurement sessions: one 2 months before and the other 6 months after foot and ankle surgery.

Study population: Twenty adult stroke survivors who are patients at the Roessingh Rehabilitation Centre, with chronic hemiplegia and walking disabilities due to an equinovarus foot deformity will participate. These stroke patients are selected clinically to undergo equinovarus surgery and are subsequently asked to participate in this study by their rehabilitation physician.

Intervention: The intervention consists of standard techniques applied in soft-tissue surgery of equinovarus foot deformities.

Main study parameters/endpoints: The main study parameters includes the effect of surgery on restoring foot and ankle kinematics (motion). Furthermore, the effects of surgery on walking ability such as walking speed and endurance and fall risk, as well as daily participation measures is assessed.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The risks for the subjects are limited, since the tasks represent functional and familiar movements and are performed within a safe environment. When fatigue occurs, the subjects are able to rest till recovered. Furthermore, a therapist may walk along with the subject in cases necessary or requested. In addition, most measurements used in this study are non-invasive and involve no risks to the subjects in any way. The only invasive measure is performed according to standard clinical procedures.

Participation of a subject in this experiment has no direct benefit for him/her, other than expanding knowledge about the effects of foot and ankle equinovarus surgery on restoring foot and ankle function and walking ability.

Exploratory study to develop hypotheses

Two measurement points:

1. One-two months before foot and ankle equinovarus soft tissue surgery

2. 6 months after surgery

The measurements will take place befor and after standard soft-tissue surgery