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A. Picelli et al.
anatomical landmarks of tibial motor nerve branches to
the gastrocnemii, soleus and tibialis posterior muscles
between legs (i.e. affected vs. healthy) within the same
individual. This was because the main aim of this study
was not to evaluate modifications in anatomical land-
marks due to spastic muscle overactivity, but to provide
information, from a clinical practice perspective, for
selective motor nerve blocks in the management of
spastic equinovarus foot due to chronic stroke. Thirdly,
we did not perform US evaluation of other nerve
branches (e.g. the tibialis posterior nerve main trunk
or the motor nerve branches to the flexor digitorum
longus and flexor hallucis longus muscles) that might
be a target for selective blocks in the management of
spastic equinovarus foot. Fourthly, no treatment (i.e.
selective nerve block with anaesthetics or therapeutic
nerve block with neurolytic agents) was given.
In conclusion, US may be useful to localize motor
nerve branches to the gastrocnemii, soleus and tibialis
posterior muscles for evaluating and treating their
spastic overactivity using neural blockade procedures.
In daily practice, US should be coupled with needle
electrical stimulation in order to maximize precise
identification of the tibialis posterior motor nerve
branches and the safety of nerve blocks by overcoming
possible difficulties due to the specific anatomy of each
patient. For clinicians without access to US, the anato-
mical landmarks proposed in this study may represent
a useful guide for identification of tibial nerve motor
branches by means of other injection techniques, such
as needle electrical stimulation. To further validate
these findings, larger scale studies are required, taking
into account the limitations reported above.
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