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Spastic equinovarus and split anterior tibialis tendon transfer (SPLATT)
78%
2626/3354
Flaccid equinovarus and medializing calcaneal ostetomy and flexor hallucis longus transfer
5%
180/3354
Spastic calcaneovalgus and split anterior tibialis tendon transfer (SPLATT)
151/3354
Flaccid equinovalgus and split anterior tibialis tendon transfer (SPLATT)
178/3354
Spastic equinovalgus and medializing calcaneal ostetomy and flexor hallucis longus transfer
6%
206/3354
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The most common physical finding in patients who have had a cerebrovascular accident is spastic equinovarus deformity of the foot and ankle (Illustration A) from an upper motor neuron injury. The equinus component is secondary to overactivity of the gastrocnemius-soleus complex. The varus is due to relative overactivity of the tibialis anterior, with lesser contributions from the FHL, FDL, and tibialis posterior. Neurologic recovery can take 6 to 18 months in patients who have had a CVA. Nonoperative management includes early intervention consisting of strengthening, maintenance of joint range of motion, splinting, phenol blocks, and botulinum toxin injections. Level 5 evidence from Botte et al states that surgical treatment is indicated if fixed contractures persist after the period of neurologic recovery passes and the deformity is not braceable. Equinus deformity is treated with lengthening of the Achilles tendon. Varus deformity is treated with a split anterior tibialis tendon transfer (SPLATT).
3.7
(24)
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