Clinical biomechanics (Bristol, Avon) · 2026
Improved gait biomechanics following surgical correction of pes equinovarus in individuals with stroke.
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Bloks Bente E, Nonnekes Jorik, Louwerens Jan Willem K, Geurts Alexander C H, Keijsers Noël L W
Аннотация
BACKGROUND: In people with stroke, pes equinovarus often leads to gait impairments. This study aimed 1) to investigate the effects of reconstructive surgery for pes equinovarus on spatiotemporal gait parameters and lower limb kinematics and kinetics, 2) to identify biomechanical determinants of changes in gait speed following surgery, and 3) to assess plantar pressure after surgical correction.
METHODS: Forty-six adults were included in this repeated measures study. Each participant underwent surgical equinovarus correction, which included tarsal arthrodesis, frequently combined with Achilles tendon lengthening. Three-dimensional instrumented gait analysis was performed before and twelve months post surgery. Plantar pressure measurements were conducted twelve months post surgery and compared to a database of healthy controls.
FINDINGS: Among the 17 participants who were able to walk barefoot before and after surgery, increased ankle dorsiflexion and a reduced ankle moment on the paretic side were observed after surgery. Post-surgical changes in gait speed were associated with changes in stride length, cadence, step length on both sides, and peak ankle power on both sides. Compared to healthy controls (n = 586), people with stroke post surgery (n = 16) demonstrated minor differences in medio-lateral center of pressure trajectory.
INTERPRETATION: Surgical correction of pes equinus led to increased ankle dorsiflexion, whereas correction of pes varus was reflected by a normalized medio-lateral center of pressure trajectory. Improvements in gait speed after surgery were associated with increased ankle push-off power on the non-paretic side, while a decrease in gait speed was associated with a decrease in ankle push-off power on the paretic side.
TRIAL REGISTRATION: The study is registered in the Overview of Medical-Scientific Research in the Netherlands (OMON; https://onderzoekmetmensen.nl/en/trial/54441).
METHODS: Forty-six adults were included in this repeated measures study. Each participant underwent surgical equinovarus correction, which included tarsal arthrodesis, frequently combined with Achilles tendon lengthening. Three-dimensional instrumented gait analysis was performed before and twelve months post surgery. Plantar pressure measurements were conducted twelve months post surgery and compared to a database of healthy controls.
FINDINGS: Among the 17 participants who were able to walk barefoot before and after surgery, increased ankle dorsiflexion and a reduced ankle moment on the paretic side were observed after surgery. Post-surgical changes in gait speed were associated with changes in stride length, cadence, step length on both sides, and peak ankle power on both sides. Compared to healthy controls (n = 586), people with stroke post surgery (n = 16) demonstrated minor differences in medio-lateral center of pressure trajectory.
INTERPRETATION: Surgical correction of pes equinus led to increased ankle dorsiflexion, whereas correction of pes varus was reflected by a normalized medio-lateral center of pressure trajectory. Improvements in gait speed after surgery were associated with increased ankle push-off power on the non-paretic side, while a decrease in gait speed was associated with a decrease in ankle push-off power on the paretic side.
TRIAL REGISTRATION: The study is registered in the Overview of Medical-Scientific Research in the Netherlands (OMON; https://onderzoekmetmensen.nl/en/trial/54441).