This is a prospective, double blinded randomized, placebo-controlled study that will be conducted on 112 adult ischemic or hemorrhagic hemiplegic stroke patients with calf muscles spasticity so as to evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in those patients. Allocation of patients into two groups after eligibility testing \& randomization will be done: Group I: patients will receive rESWT once weekly for one month , Group II: patients will receive Sham rESWT once weekly for one month. Each patient will be evaluated by the same well trained physiatrist for clinical, Electrophysiological and Musculoskeletal Ultrasound (MSKUS) assessments at baseline (t0), and after 1 month (t1) and after 2 months (t2) .
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Reduction in modified Ashworth scale (MAS) for spastic plantar flexor muscles
Timeframe: about 6 months
Improvement of Passive ankle dorsiflexion range of motion ( PADFM) .
Timeframe: about 6 months
Reduction in time required to walk 10 meters (10 MWT).
Timeframe: about 6 months
Reduction in H/M ratio.
Timeframe: about 6 months
Change in spastic calf muscles echogenicity on Heckmatt scale.
Timeframe: about 6 months