Volume 21, Issue 5, September–October 2025, 103234Author links open overlay panel, , , , , , , , , AbstractBackground

Post-stroke equinovarus foot (EVF) is a common and disabling complication of stroke, characterized by ankle plantarflexion and inversion due to muscle spasticity. It often results in abnormal gait patterns, increased risk of falls, and diminished quality of life. Although various interventions have been proposed, targeted and effective treatments remain limited.

Case Presentation

We report two patients with post-stroke EVF: a 54-year-old male 10 months after ischemic stroke, and a 37-year-old female 2 years after hemorrhagic stroke. Both exhibited spasticity of the gastrocnemius and tibialis posterior muscles, leading to asymmetrical gait and impaired mobility.

Intervention and Outcomes

Each patient underwent four sessions of ultrasound-guided acupotomy over two weeks, targeting the affected spastic muscles under real-time imaging. Quantitative gait analysis demonstrated significant improvements in the step length ratio (Case 1: 0.67 → 0.87; Case 2: 0.68 → 0.85). Secondary improvements were also observed in gait velocity, lateral symmetry, balance parameters, and Modified Ashworth Scale scores. No adverse events were reported during or after treatment.

Lessons and Implications

These cases suggest that ultrasound-guided acupotomy may serve as a precise and minimally invasive treatment for post-stroke EVF by selectively releasing spastic muscles while preserving surrounding structures. Further research is warranted to validate these findings in larger cohorts and through controlled study designs.

Keywords

Case report

Equinovarus foot

Protocol

Stroke

Ultrasound-guided acupotomy

AbbreviationsANCOVA

Analysis of covariance

CRIS

Clinical research information service

FAC

Functional ambulation category

KHIDI

Korea health industry development institute

MAS

Modified ashworth scale

NIH

National institute of health

WUGMC

Wonkwang university Gwangju medical center

© 2025 The Author(s). Published by Elsevier Inc.