Personalized combined reconstructive surgical protocols for spastic foot and ankle deformities in adult stroke: a...

Spastic foot and ankle deformities following stroke severely impair lower limb function in adults, with conservative treatments often yielding limited and short-lived results. Drawing on established experience from pediatric cerebral palsy orthopedics, we designed personalized combined surgical protocols tailored to different deformity presentations, applied them to adult stroke, and aimed to observe the feasibility and safety of the protocol for treating such complex deformities and report preliminary functional outcomes.

This single-center retrospective observational case series study included patients with post-stroke spastic hemiplegia manifesting as foot drop, varus deformity, and toe flexion spasm (claw toe deformity) between September 2023 and February 2025. The personalized functional reconstruction surgical protocol was performed based on the specific deformity, which included: (A) Achilles tendon lengthening to imporve foot drop deformity; (B) Anterior tibial tendon transfer to correct varus deformity; (C) Flexor hallucis longus(FHL) lengthening and flexor digitorum longus(FDL) tenotomy to alleviate claw toe deformity. Primary outcome measures included muscle tone assessed by the modified Ashworth scale(MAS), passive ankle range of motion(ROM), 10-meter walking time(10mWT), timed up-and-go test (TUGT), and Holden score for lower limb function.

The study included 24 patients (21 male, 3 female) with a mean age of 53.58 ± 10.30 years and a mean follow-up of 19.23 ± 4.10 months. At postoperative follow-up intervals of 3, 6, and 12 months, as well as at the final follow-up, muscle tone in the gastrocsoleus, FHL and FDL was significantly reduced compared to preoperative levels (P < 0.005). Lower limb function showed an improving trend, with increased ankle ROM and varying degrees of improvement in 10mWT, TUGT and Holden score (P < 0.05). Postoperative resting appearance of the foot and ankle was corrected, enhancing aesthetics. No serious complications occurred throughout the follow-up period.

For complex spastic foot and ankle deformities in adult stroke patients, this study developed personalized combined reconstructive surgical protocols. This retrospective case series suggests that the protocol has preliminary feasibility and safety in reducing muscle tone, improving ankle mobility, and lower limb motor function.