Introduction Acquired spastic equinovarus deformity is most commonly caused by cerebrovascular accident (CVA) traumatic brain injury (TBI) Pathophysiology equinus secondary to overactivity of the gastrocnemius-soleus complex varus due to relative overactivity of the tibialis anterior, with lesser contributions from the FHL, FDL, and tibialis posterior. Associated conditions joint contractures hyperextension of knee in stance phase Prognosis neurologic recovery can take 6 to 18 months in patients who have had a CVA 25% regain normal ambulation 75% regain some level of ambulation neurologic recovery can take years with TBI Presentation Symptoms deformity and difficulty with gait Physical exam most common physical finding is spastic equinovarus deformity increased tone hyperreflexia Imaging Radiographs recommended views AP, lateral, oblique of foot and ankle Treatment Nonoperative physical therapy, injections, orthoses indications as first line of treatment modalities therapy focus on stretching and strengthening, maintenance of joint range of motion injections phenol blocks and botulinum toxin injections are used AFO should be used while the patient is in bed or wheelchair Operative Achilles tendon lengthening with split anterior tibialis tendon transfer (SPLATT) indications fixed contractures persist after the period of neurologic recovery and are not braceable. functional deficits skin problems secondary to deformity technique equinus deformity is treated with lengthening of the Achilles tendon varus deformity is treated with a split anterior tibialis tendon transfer (SPLATT) osteotomies and fusions indications recurrence of deformity despite proper soft tissue procedures Surgical Techniques Split anterior tibialis tendon transfer (SPLATT) often done in conjunction with achilles lengthening (open or percutaneous) gastrocnemius recession lengthening or dorsal transfer of the posterior tibialis tendon (PTT) may also be necessary the tibialis anterior is split and the lateral half is attached to the cuboid through a drill hole and sutured in place Complications Hindfoot valgus inadvertent lengthening of PTT can result in over correction
QUESTIONS 1 of 1 1 Previous Next (OBQ05.236) A 65-year-old female developed a right foot deformity 3 years ago following a cerebrovascular accident. She initially underwent early intervention with physical therapy and splinting. However, passively correctable contractures persist and the braces are causing skin problems on the leg. What is the most likely foot and ankle deformity in this patient and the most appropriate surgical treatment to be combined with a planned tendoachilles lengthening (TAL)? Review Topic QID: 1122 1 Spastic equinovarus and split anterior tibialis tendon transfer (SPLATT) 80% (1737/2173) 2 Flaccid equinovarus and medializing calcaneal ostetomy and flexor hallucis longus transfer 4% (95/2173) 3 Spastic calcaneovalgus and split anterior tibialis tendon transfer (SPLATT) 4% (85/2173) 4 Flaccid equinovalgus and split anterior tibialis tendon transfer (SPLATT) 5% (106/2173) 5 Spastic equinovalgus and medializing calcaneal ostetomy and flexor hallucis longus transfer 6% (139/2173) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1
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