Introduction Simple Deformities Deformity Strong Muscle Weak Muscle Equinus Gastroc-soleus complex Dorsiflexors Cavus Plantar fascia, intrinsics Dorsiflexors Varus Posterior tib, anteiror tib Peroneal brevis Supination Anterior tibialis Peroneus longus Flatfoot Peroneus brevis Posterior tibial tendon Complex Deformities Deformity Strong Muscle Weak Muscle Equinovarus + supination Gastroc-soleus complex, posterior tibialis, anterior tibialis Peroneus brevis & longus Equinovalgus Gastroc-soleus complex, peroneals Posterior tibialis, anterior tibialis Calcaneovalgus Foot dorsiflexors/evertors (L4 and L5) Plantar flexors /inverters (S1 and S2) Introduction Equinovarus foot most common deformity following stroke use AFO and physical therapy for at least 6 months to await for possible neuro recovery overactivity of the tibialis anterior, with contributions from the FHL, FDL, and tibialis posterior treatment nonoperative AFO fitting physical therapy Phenol or botox injections surgical split anterior tibial tendon transfer (SPLATT) flexor hallucis longus tendon transfer to the dorsum of the foot and release of the flexor digitorum longus and brevis tendons at the base of each toe gastrocnemius or achilles lengthening Foot drop Inability to dorsiflex at the ankle and/or toes Commonly result from peroneal nerve palsy Multiple etiologies central nervous system (brain, spinal cord, nerve roots) peripheral nervous system (sciatic nerve, peroneal nerve) traumatic (knee dislocation, laceration, blunt trauma) compressive (compressive mass, deformity correction) systemic (diabetic polyneuropathy, mononeuropathy) Iatrogenic (laceration, casting, positioning, surgical injury) Mechanical (muscle debridement, tumor excision, etc.) Presentation - variable depending on location of nerve injury Motor Loss of ankle/toe dorsiflexion (DPN) Loss of ankle eversion (SPN) Sensory Loss of first dorsal webspace sensation (DPN) Loss of lateral leg/dorsal foot sensation (SPN) Treatment Nonoperative Observation AFO bracing Therapy - stretching and supple joints Operative Acute injury Laceration - repair, grafting, or nerve transfer Chronic injury Tendon transfer Posterior tibial tendon transfer to lateral cuneiform +/- gastroc or Achilles tendon lengthening Physical Exam Silfverskiöld test improved ankle dorsiflexion with knee flexed = gastrocnemius tightness equivalent ankle dorsiflexion with knee flexion and extension= achilles tightness