International recommendations to manage post-stroke Equinovarus Foot deformity validated by a panel of experts using DELPHI

Objective: This study intended to establish international recommendations for the management of spastic equinovarus foot deformity. Design: Delphi method SETTING: International study PARTICIPANTS: 24 international experts in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopaedic surgeons, neurosurgeons, and plastic surgeons) INTERVENTIONS: Experts answered three rounds of questions related to important aspects of diagnosis, assessment and treatment of spastic equinovarus foot deformity. Main outcome measures: A consensus was established when at least 80% of experts agreed on a statement RESULTS: : A total of 52 items reached consensus. Experts recommend assessing impact of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity and evaluate the activity of antagonist muscles. Motor nerve blocks, two-dimensional video analysis and radiological exams are often required to complement a clinical exam. The treatment of equinovarus foot depends on the correctability of the deformity, but also the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between doctors and the patient, which will define personalized attainable goals before surgery. Conclusion: The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and non-specialists to diagnoses and assess the deformity and direct patients to a network of experts, in order to optimize patient functional recovery and improve their autonomy.