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)

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.