Long-term effect of tibial nerve neurotomy in stroke patients with lower limb spasticity

Published:January 05, 2009DOI:



      We investigated the long-term effects and predictive indices of efficacy of tibial nerve neurotomy in a large series of patients with post-stroke hemiplegia.


      Fifty-one patients were prospectively included, who showed disabling lower limb deformity (equinus, varus, clawing toes). The motor branches of the tibial nerve were selected according to the type of deformity, and partially resected at the posterior part of the calf. Patients were regularly assessed, before surgery and from the third month to the second year post surgery, for spasticity (primary outcome measure), motor control, range of active and passive movements, balance, walk, gait parameters, Rivermead Motor Assessment (RMA), subjective improvement and satisfaction.


      Neurotomy definitely reduced spasticity and improved motor control on antagonist muscles, while improving balance, walk, and the RMA. These effects were clearly perceived in daily living. A discrete decline was at times observed at 2 years. Functional improvement was greater in patients more severely impaired. Side effects, consisting in sensory disorders, were observed following neurotomy of the motor fascicles of the flexor digitorum longus.


      Tibial nerve neurotomy showed great and lasting effects, and can be proposed to improve walking and balance in stroke patients with disabling lower limb deformity.


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        • Kirazli Y.
        • On A.Y.
        • Kismali B.
        • Aksit R.
        Comparison of phenol block and botulinus toxin type A in the treatment of spastic foot after stroke: a randomized, double-blind trial.
        Am J Phys Med Rehabil. 1998; 77: 510-515
        • Burbaud P.
        • Wiart L.
        • Dubos J.L.
        • Gaujard E.
        • Debelleix X.
        • Joseph P.A.
        • Mazaux J.M.
        • Bioulac B.
        • Barat M.
        • Lagueny A.
        A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients.
        J Neurol Neurosurg Psychiatry. 1996; 61: 265-269
        • Hesse S.
        • Lucke D.
        • Malezic M.
        • Bertelt C.
        • Friedrich H.
        • Gregoric M.
        • Mauritz K.H.
        Botulinum toxin treatment for lower limb extensor spasticity in chronic hemiparetic patients.
        J Neurol Neurosurg Psychiatry. 1994; 57: 1321-1324
        • Richardson D.
        • Sheean G.
        • Werring D.
        • Desai M.
        • Edwards S.
        • Greenwood R.
        • Thompson A.
        Evaluating the role of botulinum toxin in the management of focal hypertonia in adults.
        J Neurol Neurosurg Psychiatry. 2000; 69: 499-506
        • Pittock S.J.
        • Moore A.P.
        • Hardiman O.
        • Ehler E.
        • Kovac M.
        • Bojakowski J.
        • Al Khawaja I.
        • Brozman M.
        • Kanovsky P.
        • Skorometz A.
        • Slawek J.
        • Reichel G.
        • Stenner A.
        • Timerbaeva S.
        • Stelmasiak Z.
        • Zifko U.A.
        • Bhakta B.
        • Coxon E.
        A double-blind randomised placebo-controlled evaluation of three doses of botulinum toxin type A (Dysport®) in the treatment of spastic equinovarus deformity after stroke.
        Cerebrovasc Dis. 2003; 15: 289-300
        • Sindou M.
        • Mertens P.
        Selective neurotomy of the tibial nerve for the treatment of the spastic foot.
        Neurosurgery. 1988; 23: 738-744
        • Decq P.
        • Filipetti P.
        • Cubillos A.
        • Slavov V.
        • Lefaucheur J.P.
        • Nguyen J.P.
        Soleus neurotomy for treatment of the spastic equinus foot.
        Neurosurgery. 2000; 47: 1154-1160
        • Caillet F.
        • Mertens P.
        • Rabaseda S.
        • Boisson D.
        Intérêt de l'analyse tridimentionnelle de la marche, dans la prise en charge du pied spastique.
        Ann Readapt Med Phys. 2003; 46: 119-131
        • Buffenoir K.
        • Roujeau T.
        • Lapierre F.
        • Menei P.
        • Menegalli-Boggelli D.
        • Mertens P.
        • Decq P.
        Spastic equinus foot: multicenter study of the long-term results of tibial neurotomy.
        Neurosurgery. 2004; 55: 1130-1137
        • Deltombe T.
        • Detrembleur C.
        • Hanson P.
        • Gustin T.
        Selective tibial neurotomy in the treatment of spastic equinovarus foot. A 2-year follow-up of three cases.
        Am J Phys Med Rehabil. 2006; 85: 82-88
        • Rousseaux M.
        • Buisset N.
        • Daveluy W.
        • Kozlowski O.
        • Blond S.
        Comparison of botulinum toxin injection and neurotomy in patients with distal lower limb spasticity.
        Eur J Neurol. 2008; 15: 506-511
        • Collado H.
        • Bensoussan L.
        • Viton J.M.
        • De Bovis V.M.
        • Delarque A.
        Does fascicular neurotomy have long-lasting effects.
        J Rehabil Med. 2006; 38: 212-217
        • World Health Organization
        International Classification of Functioning, Disability and Health (ICF).
        2001 (http//
        • Bohannon R.W.
        • Smith M.B.
        Interrater reliability of a modified Ashworth scale of muscle spasticity.
        Phys Ther. 1987; 67: 206-207
        • Filipetti P.
        • Decq P.
        • Fontaine D.
        • Feve A.
        • Pirotte A.
        • Barbedette B.
        • Nadeau G.
        La spasticité des membres inférieurs chez l'adulte. Evaluation clinique et blocs moteurs.
        Neurochirurgie. 1998; 44: 167-174
        • Demeurisse G.
        • Demol O.
        • Robaye E.
        Motor evaluation in vascular hemiplegia.
        Eur Neurol. 1980; 19: 382-389
        • Brun V.
        • Dhoms G.
        • Henrion G.
        • Codine P.
        • Founeau H.
        • Terraza M.
        L'équilibre postural de l'hémiplégique par accident vasculaire cérébral: méthodologie d'évaluation et étude corrélative.
        Ann Réadapt Méd Phys. 1993; 36: 169-177
        • Holden M.K.
        • Gill K.M.
        • Magliozzi M.R.
        • Nathan J.
        • Piehl-Baker L.
        Clinical gait assessment in the neurologically impaired: reliability and meaningfulness.
        Phys Ther. 1984; 64: 35-40
        • Lincoln N.
        • Leadbitter D.
        Assessment of motor function in stroke patients.
        Physiother. 1979; 65: 48-51
        • Simpson D.M.
        • Alexander D.N.
        • O'Brien C.F.
        • Tagliati M.
        • Aswad A.S.
        • Leon J.M.
        • Gibson J.
        • Mordaunt J.M.
        • Monaghan E.P.
        Botulinum toxin type A in the treatment of upper extremity spasticity: a randomized, double-blind, placebo-controlled trial.
        Neurology. 1996; 46: 1306-1310
        • Tabary J.C.
        • Tabary C.
        • Tardieu C.
        • Tardieu G.
        • Goldspink G.
        Physiological and structural changes in the cat's soleus muscle due to immobilization at different lengths by plaster casts.
        J Physiol (London). 1972; 224: 231-244
        • Dietz V.
        • Quintern J.
        • Berger W.
        Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia.
        Brain. 1981; 104: 431-449
        • O'Dwyer N.J.
        • Ada L.
        • Neilson P.D.
        Spasticity and muscle contracture following stroke.
        Brain. 1996; 119: 1737-1749
        • Vattanasilp W.
        • Ada L.
        • Crosbie J.
        Contribution of thixotropy, spasticity, and contracture to ankle stiffness after stroke.
        J Neurol Neurosurg Psychiatry. 2000; 69: 34-39
        • Rousseaux M.
        • Compère S.
        • Launay M.J.
        • Kozlowski O.
        • Audubert E.
        Variability and predictability of functional efficacy of botulinum toxin injection in leg spastic muscles.
        J Neurol Sci. 2005; 232: 51-57