Condition
Spasticity of the leg and foot
Stiff, tight leg and foot muscles from brain or spinal cord injury, and options from bracing to selective tibial neurotomy.
Medically reviewed by Efe Ozturk, DPM · Last reviewed
Watch: Leg and foot spasticity explained
Read the transcript
Stiff, tight muscles in your leg, or a foot that turns in and points down? This can be spasticity. Spasticity is a motor disorder in which muscles become stiff and tight, and resist being stretched. It can interfere with daily function, hygiene and comfort, and severe cases can lead to contractures. In some people, some spasticity is useful, because it lets them stand or walk. It comes from a condition of the brain or spinal cord, such as a stroke, and not from a pinched nerve in the foot. A common pattern after a stroke is spastic equinovarus foot. The calf and foot muscles pull the foot down, and turn the sole inward. It impairs balance and mobility, and is a major cause of disability in people in neurorehabilitation. Signs include difficulty getting a shoe or brace on, pressure points, and frequent tripping. Care is led by rehabilitation physicians and neurologists. Stretching, positioning and bracing with therapy are the foundation, along with oral medicines from your physician. Botulinum toxin injections are established as effective for lower-limb spasticity in adults, though the effect wears off and injections are repeated. For selected people, selective tibial neurotomy is a permanent treatment that works on the motor branches of the tibial nerve. A review of 11 uncontrolled studies suggested that the operation could reduce impairments. In the first blinded randomized trial, of 16 people after stroke, it reduced ankle stiffness more than botulinum toxin, and neither treatment caused muscle weakening. Everyday activity and quality of life did not change significantly with either treatment. These results are encouraging, but come from small studies with short follow-up. Your rehabilitation physician or neurologist stays in charge of the overall plan. We can help work out whether a pinched or injured peripheral nerve is adding to your symptoms. Seek urgent care for sudden new weakness or numbness, especially with confusion, trouble speaking or facial drooping. To learn more, visit our website, or call the office to arrange a visit.
General education only; not a substitute for individual medical advice.
What spasticity is and what causes it
Spasticity means that muscle tone increases with the speed of a stretch. People often describe it as tightness or stiffness. It varies from subtle to severe, and it can interfere with daily function, hygiene and comfort. Severe cases can lead to contractures, which increase the risk of pressure sores. In some people, some spasticity is useful, because it lets them stand or walk.[1]
This page is about spasticity in the leg and foot. Weakness that makes the foot drop is a different problem, covered in foot drop. Spasticity comes from a central nervous system condition rather than a pinched peripheral nerve, and the two can occur in the same person.
How it affects the foot
The common pattern after a stroke is spastic equinovarus foot: the calf and foot muscles pull the foot down and turn the sole inward. It is a common dysfunctional posture after stroke, and impairs balance and mobility.[2] It is also a major cause of disability in people in neurorehabilitation, affecting daily activities, social participation and quality of life.[3]
Signs include toes that curl, a foot that turns in and walks on its outer edge, difficulty getting a shoe or brace on, pain from pressure points and frequent tripping.
How it is evaluated
A rehabilitation physician or neurologist examines muscle tone, range of motion and gait, and identifies which muscles are overactive. Tests and any diagnostic injections are arranged with the treating specialist. The plan also depends on your goals, such as walking, comfort in a brace, or ease of care.
Treatment options
- Stretching, positioning and bracing, with therapy, are the foundation.
- Oral medicines, prescribed by your physician.
- Botulinum toxin injections. In the American Academy of Neurology guideline, abobotulinumtoxinA and onabotulinumtoxinA are established as effective for lower-limb spasticity in adults (Level A).[4] The effect wears off, so injections are repeated.
- Nerve surgery. Selective tibial neurotomy is a permanent treatment for focal spasticity. It works on the motor branches of the tibial nerve that supply the overactive muscles.[5]
- Tendon surgery and other reconstruction, to correct a fixed deformity.
What the evidence says about selective tibial neurotomy
A systematic review of 11 non-randomized, uncontrolled studies suggested that the operation could reduce impairments in adults with spastic equinovarus foot. It noted that acceptance remains controversial and that a randomized trial was needed.[3] The first assessor-blinded randomized trial compared the operation with botulinum toxin in 16 people with chronic stroke. The operation produced a larger reduction in ankle stiffness, both treatments improved how the ankle moved during walking, and neither caused muscle weakening. Everyday activity, participation and quality of life did not change significantly with either treatment.[5] In a smaller group of 13 people who had not benefitted from conservative measures, walking quality, distance and speed improved at about six months, and satisfaction was high.[2]
These results are encouraging but come from small studies with short follow-up. The operation is not right for everyone, and a decision to have it is made with a rehabilitation physician and a nerve surgeon.
How this fits with the Institute
Our focus is on the peripheral nerves of the foot, ankle and lower leg. If you have spasticity, your rehabilitation physician or neurologist remains in charge of the overall plan. We can help with a related question: whether a peripheral nerve problem, such as a pinched or injured nerve, is adding to your symptoms. See nerve compression in the leg and nerve testing for foot pain.
When to seek care
Consider an evaluation if you have increasing stiffness in your leg or foot, a foot that turns in or points down, or new pain from pressure points, and you have not been assessed by a rehabilitation specialist.
References
- 1.Winkle MJ, Huang D, Lui F. Spasticity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. PubMed 29939646 (external site)
- 2.LaMarca AL, Krenn MJ, Kelso-Trass MA, MacDonald KC, Demeo CC, Bazarek SF, et al. Selective Tibial Neurotomy Outcomes for Spastic Equinovarus Foot: Patient Expectations and Functional Assessment. Neurosurgery. 2023;93(5):1026-1035. PubMed 37199494 (external site)
- 3.Bollens B, Deltombe T, Detrembleur C, Gustin T, Stoquart G, Lejeune TM. Effects of selective tibial nerve neurotomy as a treatment for adults presenting with spastic equinovarus foot: a systematic review. J Rehabil Med. 2011;43(4):277-82. PubMed 21305231 (external site)
- 4.Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache [RETIRED]: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016;86(19):1818-26. PubMed 27164716 (external site)
- 5.Bollens B, Gustin T, Stoquart G, Detrembleur C, Lejeune T, Deltombe T. A randomized controlled trial of selective neurotomy versus botulinum toxin for spastic equinovarus foot after stroke. Neurorehabil Neural Repair. 2013;27(8):695-703. PubMed 23757297 (external site)
This page is general health information and isn’t a substitute for advice from a clinician who knows your history. Read our medical disclaimer and how we review content.
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