Publications

• The validity of the Myoton PRO is strongly supported by Spearman’s rank correlation analysis, which indicates a strong association between muscle tone and disability level (rs = 0.80, p < 0.05), as well as between muscle stiffness and disability level (rs = 0.81, p < 0.05).

Stroke remains a leading global contributor to disability and functional limitation, with ischemic events accounting for approximately 85% of all cases. In Egypt, stroke represents approximately 6.4% of total deaths, with a growing prevalence among younger individuals. Spasticity is a common post-stroke motor disorder with highly variable reported prevalence estimated between 4% and 42.6%. Although spasticity can occasionally assist certain functional movements, it more often constitutes a significant impairment that restricts motor performance in many stroke survivors. Plantar flexor spasticity plays a critical role in post stroke balance and gait dysfunction by reducing the joint range of motion and increasing stiffness of muscles and periarticular tissues. Stroke survivors frequently experience impairments across motor, sensory, and higher cognitive domains, which collectively degrade postural control. Hemiplegic patients commonly demonstrate impaired weight-shifting ability, increased postural sway, asymmetrical weight distribution, and diminished stability. Falls are one of the most common consequences of stroke patients, with a reported frequency ranging from 7% in the first week following stroke to 73% in the first year after being discharged from hospital. Spasticity of the plantar flexors disturbs walking, can impede toe clearance during the swing phase of gait, increasing fall risk as a result their toe ‘catching’ on the ground. Characteristically, post-stroke limbs exhibit relative over activity of extensors and weakness of flexors, contributing to gait abnormalities and reduced functional mobility.

Keywords: stroke, plantar flexor spasticity, fall risk, gait dysfunction, functional limitation

Plantar flexor spasticity remains a prevalent and debilitating complication following stroke, substantially limiting postural stability, gait efficiency, and overall functional independence. This review highlights that increased muscle tone in the ankle extensors significantly disrupts the biomechanics of balance, leading to an increased risk of falls and reduced mobility. Clinically, practitioners should prioritize early assessment and targeted interventions—such as stretching, strengthening, and neurorehabilitation techniques—tailoring treatment parameters based on the severity of spasticity and the patient’s specific functional goals. Managing ankle spasticity is not merely about reducing muscle tone but is a critical step toward restoring postural control and enhancing the quality of life for stroke survivors.

Future research should prioritize well-designed randomized controlled trials that explore the long-term effects of combined therapeutic modalities on dynamic balance. Additionally, studies investigating the correlation between quantitative spasticity measures and real-world functional outcomes will proovide valuable guidance for evidence-based physiotherapy practice. Such efforts will contribute to refining clinical guidelines and maximizing functional recovery for patients post-stroke.