Selective Neurotomy of the Tibial Nerve in the Spastic Hemiplegic Child: An Explanation of the Recurrence

A series including 13 unilateral selective tibial neurotomies for spastic foot in hemiplegic children is reported. The results were considered excellent in three cases. Two cases needed additional corrective casts postoperatively. Eight cases had poor result with recurrence of the same deformity. The authors conclude that the effect of tibial neurotomy for spastic foot in hemiplegic children is transient in 61% of cases with a recurrence of the same deformity. Four of the patients with failed treatment underwent orthopedic surgery with muscle biopsies. Histologic data clearly demonstrate that previously de-nervated muscle fibers were reinnervated carrying into extensive motor units. This finding can explain the recurrence of the foot spasticity and deformity in neurotomized children.