Evaluation of the Long-Term Effect of Selective Tibial Neurotomy for the Treatment of Spastic Foot Using a Personal Goal-Centered Approach

OBJECTIVE The objective of this study was to evaluate the long-term effectiveness of selective tibial neurotomy (STN) for the treatment of the spastic foot using a goal-centered approach. METHODS Between 2011 and 2018, adult patients with a spastic foot (regardless of etiology) who received STN followed by a rehabilitation program were included. The primary outcome was the achievement of individual goals defined preoperatively (T-0) and compared at 1-year (T-1) and 5-year (T-5) follow-up by using the Goal Attainment Scaling methodology (T-score). The secondary outcomes were the presence of spastic deformities (equinus, varus, and claw toes), modified Ashworth scale (MAS) score for the targeted muscles, and modified Rankin Scale (mRS) score at T-0, T-1, and T-5. RESULTS Eighty-eight patients were included. At T-5, 88.7% of patients had achieved their goals at least "as expected." The mean T-score was significantly higher at T-1 (62.5 +/- 9.5) and T-5 (60.6 +/- 11.3) than at T-0 (37.9 +/- 2.8) (p < 0.0001), and the difference between T-1 and T-5 was not significant (p = 0.2). Compared to T-0, deformities (equinus, varus, and claw toes; all p < 0.0001), MAS score (p < 0.0001), and mRS score (p < 0.0001) were significantly improved at T-1 and T-5. Compared to T-1, MAS score increased slightly only at T-5 (p = 0.05) but remained largely below the preoperative value. There was no difference between T-1 and T-5 regarding other clinical parameters (e.g., deformities, walking abilities, mRS score). CONCLUSIONS This study found that STN associated with a postoperative rehabilitation program can enable patients to successfully achieve personal goals that are sustained within a 5-year follow-up period.