International Journal of Physical Medicine & Rehabilitation

International Journal of Physical Medicine & Rehabilitation
Open Access

ISSN: 2329-9096

+44 1300 500008


Split Anterior Tibialis Tendon Transfer (Splatt) and Achilles Tendon Lengthening for The Correction of The Varus Foot after Stroke a Prospective Longitudinal Study

Thierry Deltombe, Philippe Decloedt, Jacques Jamart, Delphine Costa, Pauline Leboul and Thierry Gustin

Background: The imbalance between tibialis anterior and peroneus activation in the swing phase of gait after stroke is responsible for an ankle varus leading to foot instability and poor quality of gait. In such case, a split anterior tibialis tendon transfer (SPLATT) procedure is indicated to correct imbalance. The aim of the study was to prospectively evaluate the effect of the SPLATT procedure in varus foot after stroke. Methods: We prospectively evaluated 26 consecutive hemiplegic patients (mean age 48.3 ± 10.2 years) with a varus foot operated for a SPLATT and an Achilles tendon lengthening procedure with a 6 months follow-up. Before and 6 months after surgery, the spasticity (Ashworth scale), muscle strength (MRC scale), active and passive ankle range of motion, gait parameters (10 meter walking test), gait kinematics (video) and need for assistive device were assessed. Results: A decrease in triceps spasticity and an increase in ankle dorsiflexion were observed. The varus in swing and stance phase of gait was improved. After surgery, 90% of the patients didn’t fit their ankle foot orthosis in comparison with 30% before. In contrast, gait speed, proximal spasticity, hip and ankle gait kinematics and need for crutches remained unchanged. Conclusion: This study is the first prospective study using objective validated scales confirming that the SPLATT procedure in combination with Achilles tendon lengthening is able to correct the varus and to reduce the need for orthosis in stroke patients with varus foot. Level of Evidence: Level IV / Prospective longitudinal case series study