To Evaluate The Predominant Role In Patients With Spastic Equinus Foot After Stroke: A Clinical Study Of The Effects Of Block Of Motor Nerve Branches To The Triceps Surae Muscle

Objective:To evaluate the prominent role of the triceps surae muscle through selective anesthetic blocks of motor nerve branches to the triceps surae muscle on lower limb in patient with spastic equinus foot.Methods:Thirty patients with stroke were assessed before and after selective anesthetic block of the superior soleus nerve or the gastrocnemius nerve, performed by lidocaine injection, Clinical assessment such as SR(stretch reflex,Ashworth scale,rROM(rest range of motion),AROM(active range of motion,),PROM(passive range of motion,),strength of plantarflexion muscle,walking speed for 10m(at cosy speed and volant speed, separately),cadence,walking distance for 3mins,PCI (physical consume index),step length,toe out angle were performed 30mins before and after each motor block. we devided into three groups, they are preoperative-postgastrocnemius,preoperative-postsoleus,postgastrocnemius-postsoleus separately,and we compared differences in these indicators.Results:Spasm index such as stretch reflex, Ashworth scale, AROM and PROM were all decreased in postgastrocnemius, there were statistically differences compared with preoperative,(p all＜0.01). Stretch reflex, Ashworth scale, rROM,AROM and PROM were all decreased in postsoleus, (p all＜0.01); there are significant differences between two blocks in each of them, they showed that on SR,AROM and PROM p all＜0.01,, on Ashworth,rROM p all＜0.05; Plantar flexor muscle strength decreased in postgastrocnemius(p＜0.01) but not in postsoleus, comparison of two blocks p<0.01; there were no significant differences on walking targets in postgastrocnemius but there were statistically differences in postsoleus except for walking distance for 3mins compared with preoperative, on walking speed for 10m at volant speed and cadence p all <0.01, on walking speed for 10m at cosy speed and PCI p all<0.05.Also there were significant difference between the two blocks except for walking distance for 3mins,they showed that on walking speed for 10m at cosy speed p<0.05,other index p all＜0.01. There were no significant difference for step length and toe out angle in the affected side compared with preoperative,also no statistically difference was observed between the two blocks in the affected side.Conclusions:Both soleus nerve block and gastrocnemius nerve block could alleviate spasticity in patients with spastic equinus foot, but soleus nerve block appeared more appropriate than gastrocnemius nerve block to relieve spasticity clinically, which mainly manifested in people's walking ability, and it didn't decrease plantar flexor muscle strength.It constitutes an additional argument in favor of the predominant role of the soleus in spastic foot.