Comparison of phenol and alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for treatment of spastic foot after stroke: a randomized controlled pilot study.

Aim: The aim of this paper was to determine whether the injection of alcohol or phenol into the tibialis posterior nerve relive the symptoms and signs of ankle plantar flexor spasticity.

Methods: Twenty patients with hemiplegic stroke were included. Patients were randomly assigned to receive a single treatment of alcohol or phenol injection to the motor branches of tibial nerve. Clinical outcome parameters were measured before Motor branch block, immediately, and at 1, 3, and 6 months after blocking. These parameters included a. Ankle plantar flexor spasticity assessed by Modified Ashworth Scale, b. Clonus of the ankle; c. The passive range of motion changes measured by goniometer and d. Motor strength of the ankle plantar flexors measured by the Medical Research Council grades 0-5.

Results: In the alcohol group the spasticity score for the ankle plantar flexor was reduced in all 10 patients immediately after motor branch block and this was maintained over the 6 month follow up period in 9 patients. In the phenol group the spasticity score for the ankle plantar flexor was reduced in all 10 patients immediately after motor branch block and it was maintained over the 6 month follow up period in 7 patients.

Conclusion: It was observed that both two methods are effective in reducing spasticity however the use of 50% alcohol as a neurolytic agent in the management of ankle plantar flexor spasticity appears to be long lasting method of regional spasticity treatment.