ORIGINAL RESEARCH
International Recommendations to Manage Poststroke Equinovarus Foot Deformity Validated by a Panel of Experts Using Delphi

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Abstract

Objective

To establish international recommendations for the management of spastic equinovarus foot deformity.

Design

Delphi method.

Setting

International study.

Participants

A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons).

Interventions

Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity.

Main Outcome Measures

A consensus was established when at least 80% of experts agreed on a statement

Results

A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery.

Conclusion

The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.

Section snippets

Methods

This study used a Delphi process, which is a rigorous approach to define consensus when evidence is lacking.13,14

The questionnaire evolved over the course of the 3 rounds (supplemental appendix S1, available online only at http://www.archives-pmr.org). After obtaining answers from the first questionnaire (supplemental appendix S2, available online only at http://www.archives-pmr.org), members from the steering committee wrote a second questionnaire that had questions deleted, reformulated, or

Results

Results are presented following the usual process for the management of EVF.

Discussion

Currently, no international recommendations exist describing the management of EVF in patients with spastic paresis hemiplegia after stroke and/or after central nervous system injury. Since the first international Symposium of Neuro-Orthopedics in Versailles (2017), the experts in the field of neuro-orthopedic have been gathered together biannually to share the knowledge of their clinical experience across disciplines. From this collaboration, we embarked on creating recommendations for the

Conclusions

This study was performed to address the absence of recommendations for the management of EVF. We developed these first guidelines using a Delphi process to provide unanimity on the process of diagnosing, assessing, and treating EVF. The establishment and dissemination of this information to physicians, specialists, and nonspecialists should make it possible to direct these specific patients to a network of experts to optimize patient functional recovery and improve their autonomy to facilitate

Acknowledgment

We thank Oscar Haigh for the English corrections.

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  • Supported by Allergan, an AbbVie company. The authors acknowledge Orpea-Clinea and Lagarrigue SA for providing funding to support the realization of the study.

    Disclosures: A.P. received unrelated funding from Allergan-Abbvie, Ipsen, and Merz. N.S.N. received unrelated funding from Ipsen. P.R. received unrelated funding from Abbott, Boston Scientific, Medtronic, Allergan-Abbvie, Ipsen, and Merz. S.C. received unrelated funding from Merz, Allergan-Abbvie, Ipsen, Almirall, Roche, Biogen, and Medtronic. T.D. received unrelated funding from Abbvie, IPSEN, and Merz. The other authors have no additional disclosures.

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