Equinovarus is the most common lower extremity deformity seen after a stroke. Despite its frequency, there are no specific
guidelines in determining when surgery should be considered and for which patients it is appropriate. We evaluated the charges
of nonsurgical and surgical treatments for equinovarus foot in 29 consecutive patients who underwent surgery for a unilateral
equinovarus deformity after stroke. Twenty-six patients (seven males, 19 females) were available for followup. Mean patient
age at the time of stroke was 48.2 years (range, 3–66 years). The average age at surgery was 54.7 years (range, 23–72 years),
with a mean duration of nonsurgical treatment of 74.7 months. The minimum followup was 6 months following surgery (mean, 18.2 months;
range, 6–48 months). Physical therapy accounted for 88% of nonoperative charges, with chemodenervation and orthotics accounting
for 10% and 2%, respectively. Postoperatively, 19 patients were able to discontinue physical therapy compared with none preoperatively,
and 17 discontinued orthotic use. Surgical correction of the equinovarus foot, in the appropriate patient, can decrease the
use of nonoperative care for a patient who has had a stroke. We recommend surgery be considered earlier when an equinovarus
deformity persists after the period of spontaneous neurologic recovery.
Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent was obtained.