Ultrasound-guided acupotomy for post-stroke equinovarus foot beyond the rehabilitation golden period: Two CARE-compliant case reports

Abstract

Background: 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.