# Restoring Biomechanical Gait Function with Ultrasound-Guided Acupotomy for Post-Stroke Equinovarus Foot: Two Case Reports and a Protocol (A CARE- and SPIRIT-Compliant Study)

## TL;DR

This study explores using ultrasound-guided acupotomy to improve gait in stroke patients with foot deformities, showing promising results in two cases.

## Contribution

The study introduces a novel protocol for ultrasound-guided acupotomy targeting spastic muscles in post-stroke EVF.

## Key findings

- Both patients showed significant improvements in step length ratios and gait symmetry after treatment.
- No adverse events were reported, suggesting the intervention is safe.
- A prospective randomized trial is proposed to validate these findings.

## Abstract

Background: Post-stroke equinovarus foot (EVF) impairs gait stability, increases the risk of secondary injuries, and contributes to elevated healthcare costs. However, effective targeted interventions for EVF remain limited. Patient concerns: Two patients with chronic EVF—a 63.5-year-old male (9.7 months post-stroke) and a 35.7-year-old female (24.5 months post-stroke)—presented with ankle deformity, gait asymmetry, and impaired balance, all of which interfered with daily activities. Intervention and outcomes: Both patients underwent ultrasound-guided acupotomy targeting spastic ankle muscles, administered over four sessions within two weeks. A quantitative gait analysis revealed substantial improvements in step length ratios (Case 1: 0.61 → 0.86; Case 2: 0.67 → 0.88), as well as enhancements in walking velocity, lateral symmetry, postural balance, and Modified Ashworth Scale scores. No adverse events were reported. Protocol proposal: Based on these observations, a prospective randomized controlled trial is planned to compare ultrasound-guided acupotomy plus conventional therapy versus conventional therapy alone. Outcomes will be assessed quantitatively using gait analysis. Lessons and implications: Ultrasound-guided acupotomy may offer a minimally invasive, targeted approach to releasing spastic muscles while preserving neurovascular structures, thereby improving gait function in patients with post-stroke EVF.