Abstract
Objective
To establish international recommendations for the management of spastic equinovarus
foot deformity.
Design
Delphi method.
Setting
International study.
Participants
A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different
specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians,
orthopedic surgeons, neurosurgeons, plastic surgeons).
Interventions
Experts answered 3 rounds of questions related to important aspects of diagnosis,
assessment, and treatment of spastic equinovarus foot deformity.
Main Outcome Measures
A consensus was established when at least 80% of experts agreed on a statement
Results
A total of 52 items reached consensus. Experts recommend assessing effect of the deformity
on functional activities before treatment. Before treatment, it is crucial to differentiate
spastic muscle overactivity from soft tissue contractures, identify which muscles
are involved in the deformity, and evaluate the activity of antagonist muscles. Motor
nerve blocks, 2-dimensional video analysis, and radiologic examinations are often
required to complement a clinical examination. The treatment of equinovarus foot depends
on the correctability of the deformity and the patient's ability to stand or walk.
The preoperative assessment should include an interdisciplinary consultation that
must finalize a formal agreement between physicians and the patient, which will define
personalized attainable goals before surgery.
Conclusion
The establishment of guidelines on managing equinovarus foot will help physicians
and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity
and direct patients to a network of experts to optimize patient functional recovery
and improve their autonomy.
Keywords
List of abbreviations:
BoNTA (botulinum toxin type A), EVF (equinovarus foot), PRM (physical and rehabilitation medicine)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 28, 2022
Accepted:
July 30,
2022
Received in revised form:
June 27,
2022
Received:
March 1,
2022
Footnotes
Supported by Allergan, an AbbVie company. The authors acknowledge Orpea-Clinea and Lagarrigue SA for providing funding to support the realization of the study.
Disclosures: A.P. received unrelated funding from Allergan-Abbvie, Ipsen, and Merz. N.S.N. received unrelated funding from Ipsen. P.R. received unrelated funding from Abbott, Boston Scientific, Medtronic, Allergan-Abbvie, Ipsen, and Merz. S.C. received unrelated funding from Merz, Allergan-Abbvie, Ipsen, Almirall, Roche, Biogen, and Medtronic. T.D. received unrelated funding from Abbvie, IPSEN, and Merz. The other authors have no additional disclosures.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
