16 patients who experienced spastic hemiparesis secondary to stroke and spastic equinovarus of the foot (SEF) due to over activity of the calf muscle, were randomly assigned into 1 of 2 treatment groups to determine if tibial nerve neurotomy (TNN) was as effective as botulin toxin injections in the treatment of spastic equinovarus of the foot in terms of body function and structure domain, activity, participation, and quality of life. Results of the study indicated that TNN lead to a higher reduction in ankle stiffness following treatment. However, both treatments lead to comparable improvements in ankle kinematics during gait, and neither induced muscle weakening following intervention. Activity, participation, and quality of life did not change in either group during the treatment/ follow-up period.