A Sonographic and Functional Study of the Patterns of Changes in the Tibialis Anterior Muscle in Chronic Hemiplegic Patients, a Pilot Study.

Introduction: Chronic stroke frequently causes structural and functional impairments in the tibialis anterior (TA) muscle, leading to foot-drop and altered gait kinematics. We investigated the relationship between ultrasonographic parameters of the TA muscle and functional gait performance in chronic stroke survivors. Methods: This cross-sectional, observational pilot study evaluated eight consecutive chronic stroke patients (>6 months post-stroke). Structural parameters of TA (rest and contraction thickness, pennation angle) were documented by ultrasound imaging. A dynamic feature calculated was the Contraction Index (CI = effort/resting thickness). Functional metrics included the Medical Research Council (MRC) muscle strength scale and the 10-Meter Walk Test (10MWT) for gait velocity. Results: Statistical analysis revealed a moderate negative correlation trend between resting TA muscle thickness and functional gait speed (r = -0.618, p = 0.102). Conversely, a moderate positive correlation trend was found (r = 0.548, p = 0.160). Ultrasound imaging successfully differentiated three distinct pathological phenotypes: an atrophic phenotype (low pennation angle, flaccid muscle failure), a severely shortened spastic phenotype (increased resting thickness, high pennation angle, pathological CI < 1.0), and a spastic co-contraction loop. Patients with the atrophic phenotype achieved high mechanical efficiency with an ankle-foot orthosis (AFO), whereas the spastic phenotype exhibited resistance against the orthotic device. Conclusions: Musculoskeletal ultrasound provides objective parameters for post-stroke TA muscle remodeling and contributes to completing the assessment and therapy. Identifying specific structural muscle phenotypes allows clinicians to optimize target-specific neurorehabilitation strategies, predict AFO efficiency, and guide antispastic interventions such as botulinum toxin injections.