RECONSTRUCTION OF EQUINOVARUS DEFORMED FOOT DUE TO CEREBROVASCULAR DISEASE
S. Morita, H. Yamamoto, K. Shinomiya (Tokyo Medical and Dental University, Tokyo, Japan)
Purpose: We reviewed surgical reconstruction of equinovarus deformed foot due to cerebrovascular disease and analyzed walking ability.
Methods: One hundred sixty five patients were treated with tendon transfer for equinovarus deformity and 125 patients out of them were followed at least 2 years, with an average follow-up 35 months (24 to 72). The average age of the patients was 57 years (38 to 78) and the average interval from the onset of hemiplegia to the operation was 23 months (6 to 132). All had been treated with an ankle-foot orthosis before surgery. Anterior transfer of the long toe flexors was performed in 110 patients and lateral transfer of the anterior tibial tendon in 15. All patients underwent the lengthening of Achilles tendon. We evaluated the walking ability and analyzed gait by measurement of ground reaction force before and after surgery.
Results: Ninety nine out of 125 patients could walk without a brace 4 months after surgery and 90 patients at 2 years or more. Recurrence of varus deformity was found in 19 patients and hammer-toes had recurred in 27 patients. The number of patients who could walk outdoors increased from 52 to 75 at the latest follow-up. In gait analysis, the vertical component of the affected limb became larger relatively, and the acceleration force became larger and neared to the normal value in the affected limb after surgery.
Conclusion: Surgical reconstruction of equinovarus deformed foot is a useful treatment for equinovarus deformity and the patients could walk without a brace and improve their walking ability after surgery.
STROKE - IDENTITY LOSS AND SEXUALITY
E. Greve, MD: Department of neurology, Holstebro, Danmark
Stroke is a severe disease that affects many aspect of the victims lives. Sexuality is related to a number of other essential items such as identity, body-image, dependency, self-esteem and self-confidence. Therefore, sexual problems following stroke may have their origin in physical changes, but may also reflect other items as well.
Rehabilitation of stroke patients ought to include these important aspects of life.
Rehabilitation team may cope with the patients sexual problems in a way, that allow the patients and their relatives to find own solutions. Furthermore, the staff should be familiar with physical and psychological connections and interferences with sexual problems.