Short-wave diathermy for spastic equinus foot in chronic stroke patients: a proof-of-concept pilot study.

BACKGROUND: Physical modalities may be useful to manage poststroke spasticity. Shortwave diathermy has been demonstrated to improve extensibility of the myotendinous tissue. Spasticity may alter morphology of the muscle and its elastic properties. Our main aim was to evaluate the effects of shortwave diathermy on spastic equinus foot in stroke patients. METHODS: Ten chronic stroke patients with spastic equinus foot received 10 shortwave diathermy sessions, 5 days/week for 2 consecutive weeks to the spastic calf muscles. Clinical (modified Ashworth Scale and ankle dorsiflexion passive range of motion) and ultrasound (spastic gastrocnemius muscle echo intensity and hardness percentage measured by sonoelastography) evaluation was done before, after treatment, and at two weeks of follow-up. RESULTS: A significant difference in calf muscle spasticity (P=0.004), ankle passive range of motion (P=0.014), and spastic gastrocnemius muscle hardness percentage (P=0.004) was found after treatment. A significant difference in calf muscle spasticity (P=0.004) was found also at the follow-up evaluation. CONCLUSIONS: Our preliminary findings support the hypothesis that shortwave diathermy might improve calf muscle tone, ankle passive range of motion, and gastrocnemius muscle elasticity in chronic stroke patients with spastic equinus. This might be due to the deep thermal effects coupled with the rheological direct action of shortwave diathermy on spastic muscles.

Does Botulinum Toxin Treatment Affect the Ultrasonographic Characteristics of Post-Stroke Spastic Equinus? A Retrospective Pilot Study.

Equinovarus/equinus foot is a pattern most commonly treated with botulinum toxin type A in patients with post-stroke spasticity involving the lower limbs; the gastrocnemius is the muscle most frequently injected. Spastic equinovarus/equinus can present a mixture of conditions, including spasticity, muscle/tendon shortening, muscle weakness and imbalance. In this study, we wanted to determine whether botulinum toxin treatment affects the ultrasonographic characteristics of post-stroke spastic equinus. The same dose of AbobotulinumtoxinA was injected into the gastrocnemius medialis and lateralis of 21 chronic stroke patients with spastic equinus. Clinical (Ashworth scale and ankle range of motion) and ultrasound (conventional and sonoelastography) evaluation of the treated leg was carried out before and 4 weeks after injection. No significant effects of botulinum toxin treatment on the ultrasonographic characteristics of spastic equinus were observed. As expected, there were significant improvements in ankle passive dorsiflexion range of motion and calf muscle spasticity at 1 month after treatment. There was a direct association between Achilles tendon elasticity and calf muscle spasticity at baseline evaluation. Larger studies with a long-term timeline of serial evaluations are needed to further investigate the possible effects of botulinum toxin injection on spastic muscle characteristics in patients with post-stroke spasticity.