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07/06/2005    Joel Greenwald, DPM

Spasm of the Flexors, Post Stroke

Query: Spasm of the Flexors, Post Stroke


I have a 75 year old stroke victim left side who
exhibited spasm of the flexors lesser toes left
foot.There was no evidence of drop foot or other
paralysis. She had problems walking with the
lesser toes curling under which caused her alot
of discomfort. One year ago I performed flexor
set tenotomies of all the lesser toes which
resolved her problem. Today, while the lesser
toes are straight she now has curling under of
the hallux. Here too it is a reducible
deformity.


Does anyone have experience with a flexor
tenotomy of the hallux via a stab incision? Can
I achieve long lasting results as on the lesser
toes? Are there additional complications
associated with a flexor tenotomy of the hallux
as opposed to the lesser toes, i.e., will the
EHL overpower the flexor and cause a worse
deformity? Due to the patient’s health status, I
am looking to achieve maximum results with
minimal invasiveness. Conservative measures have
failed. Any input would be appreciated.


Joel Greenwald, DPM
Israel


Other messages in this thread:


07/12/2005    Stanley Beekman, DPM

Spasm of the Flexors, Post Stroke (Joel Greenwald, DPM)

RE: Spasm of the Flexors, Post Stroke (Joel
Greenwald, DPM)
From: Stanley Beekman, DPM


Years ago, I did a flexor tenotomy on a non-CVA
patient and found out that since the toe loses
purchase, the metatarsal developed additional
pressure and problems. I did not do this
procedure until I had a patient with the same
condition you described. I also performed
tenotomies on the lesser digits, and the patient
was also pleased. Six months later she also
developed a flexible hallux hammer toe. I
performed the hallux flexor tenotomy. I recently
saw the patient at about 8 years post op, and
she is still pleased with the results.


Patients post-CVA do not have a normal
propulsive gait, and therefore do not need the
digital flexors to purchase the ground at push
off to off-load the metatarsals (because there
is no push off). This is why this procedure will
work in this situation.


Stanley Beekman, DPM
Cleveland, OH


07/08/2005    Matthew Roberts, DPM

Spasm of the Flexors, Post Stroke (Joel Greenwald, DPM)

RE: Spasm of the Flexors, Post Stroke (Joel
Greenwald, DPM)


I have had success treating this with a fusion
of the PIP joint and a
lengthening procedure of the FHL at the ankle.


Matthew Roberts, DPM
Miami, OK


07/07/2005    Multiple Respondents

Spasm of the Flexors, Post Stroke (Joel Greenwald, DPM)

RE: Spasm of the Flexors, Post Stroke (Joel
Greenwald, DPM)
From: Multiple Respondents


I have had at least 4 patients that I have done
flexor tenotomies
on their great toes and have had excellent
results long term. Two were dropfoot injuries
from auto accidents and two were from strokes.
One of the auto injuries was using an AFO prior
to the tenotomies and found she did not need it
anymore. I've done many FLH tenotomies on
diabetics, post-op complications etc. all with
good to excellent results.


Anthony DeLuca, DPM
Roseville, MI
tonydrdude@yahoo.com


For patients with spasticity following a stroke
or spinal injury, we
sometimes refer to a neurologist for injections
of Botox. They have to
be repeated but are often very helpful.


Alan Kalker, DPM (Similar, Sloan Gordon, DPM)
Middleton, WI


Years ago, I did a flexor tenotomy on a non-CVA
patient and found out
that since the toe loses purchase, the
metatarsal developed additional
pressure and problems. I did not do this
procedure until I had a
patient with the same condition you described. I
also performed
tenotomies on the lesser digits, and the patient
was also pleased. Six
months later she also developed a flexible
hallux hammer toe. I
performed the hallux flexor tenotomy. I recently
saw the patient at
about 8 years post op, and she is still pleased
with the results.


Patients post CVA do not have a normal
propulsive gait, and therefore
do not need the digital flexors to purchase the
ground at push off to
off-load the metatarsals (because there is no
push off). This is why
this procedure will work in this situation.


Stanley Beekman, DPM
Cleveland, OH

Integrity Orthotics