Comparing Tibial Nerve Selective Neurotomy and Botulinum Toxin Injections for Treating Spastic Foot in Adults After Stroke Using a Goal-focused Approach

What this Trial Is About

This research focuses on adults who have experienced a stroke resulting in hemiparesis and spastic foot conditions such as equinovarus and toe claw due to muscle spasticity. The study compares two treatments tibial nerve selective neurotomy STN and botulinum toxin A BoNT-A injections. It aims to determine which treatment better reduces calf muscle spasticity and improves personal goals related to balance, walking, self-care, and quality of life for patients with post-stroke spastic foot. Participants are randomly assigned to one of two groups. The STN group will undergo surgery within three months after enrollment, targeting specific muscles defined before randomization. The procedure lasts about 90 minutes and requires a pre-anaesthetic evaluation. The BoNT group will receive botulinum toxin injections guided by electromyography, electrical stimulation, or ultrasound. Physicians may choose between two approved botulinum toxin formulations and determine the dosage and targeted muscles based on clinical guidelines and experience. Treatments are spaced at least three months apart. Throughout the 14-month study, participants will be assessed for progress toward personal goals using the Goal Attainment Scaling. Researchers will also evaluate functional outcomes, spasticity severity, ankle motion, pain levels, walking speed and distance, use of antispastic medication, adverse events, and patient satisfaction. These assessments aim to provide a comprehensive understanding of the impact of each treatment on spastic foot symptoms and daily living activities after stroke.

Evaluation of Tibial Nerve Selective Neurotomy Compared to Botulinum Toxin Injections for Spastic Foot Treatment in Post-stroke Patients According to a Goal-centered Approach