Surgical correction of pes equinovarus in people with stroke: effects on personalized goal attainment and balance and gait capacity.

Abstract

The aim of this study was to investigate the effect of surgical correction of pes equinovarus on personalized goal attainment and balance and gait capacity. In this prospective observational cohort study, outcome measures were assessed before and twelve months after surgery. For a subgroup of participants, a 4-month baseline period with repeated assessments was used. Participants were recruited between 2019 and 2023 at a tertiary referral center. Adults with pes equinovarus deformity following chronic stroke. All participants underwent reconstructive surgery for pes equinovarus, involving tarsal arthrodesis as principal procedure, often combined with a form of Achilles tendon lengthening. Personalized goal attainment, balance capacity, and gait capacity were assessed with the Canadian Occupational Performance Measure (COPM), the Mini Balance Evaluation Systems Test (Mini-BESTest), and barefoot three-dimensional instrumented gait analysis, respectively. Forty-six participants were included. No changes in COPM, Mini-BESTest, and gait speed were observed during the 4-month baseline period. Following surgery, significant improvements were found in personalized goal attainment, with COPM-performance increasing by 3.5±1.7 points (p<0.001) and COPM-satisfaction increasing by 3.9±1.8 points (p<0.001). Balance capacity also showed significant improvement after surgery (Mini-BESTest: +5.1±5.4, p<0.001). The vast majority of participants who were unable to walk barefoot prior to surgery were able to do so post surgery (19/24 participants). Furthermore, improvements in barefoot gait speed after surgery were found in participants with low pre-surgical gait speeds. Improvements in personalized goal attainment and balance and gait capacity after reconstructive surgery for pes equinovarus were clinically relevant. Therefore, reconstructive surgery for pes equinovarus, with tarsal arthrodesis as principal procedure, can be considered as a valuable treatment in people with chronic stroke. Our findings provide guidance for optimal pre-operative counseling.