Radial Extracorporeal Shock Wave Therapy as an Adjunct to Botulinum Toxin Type A for Post-Stroke Lower Limb Spasticity (SOLUTION)

The goal of this pilot clinical trial is to determine whether radial extracorporeal shock wave therapy (rESWT), when used as an adjunct to ultrasound-guided botulinum toxin type A (BoNT-A) injections, can enhance the therapeutic effect of BoNT-A in adults with post-stroke lower-limb spasticity. The study will also evaluate the safety and tolerability of the combined treatment. The main questions it aims to answer are: * Does the addition of active rESWT to BoNT-A result in a greater improvement in lower-limb spasticity, measured by the change in Modified Ashworth Scale score from baseline to 5 weeks after treatment? * Does adjunctive rESWT improve other measures of muscle spasticity, ankle mobility, gait performance, perceived global improvement, and pain, and is the treatment safe and well tolerated? Researchers will compare BoNT-A combined with active rESWT with BoNT-A combined with sham rESWT to determine whether the addition of active rESWT provides greater clinical benefit. Participants will: * Receive ultrasound-guided BoNT-A injections according to the study protocol. * Receive either active rESWT or sham rESWT according to their randomly assigned treatment group. * Attend scheduled follow-up visits for assessment of spasticity, ankle range of motion, gait performance, muscle length, global clinical improvement, pain, and treatment safety. * Complete the planned assessments during the follow-up period, including evaluation at 5 weeks after treatment and subsequent follow-up assessments for up to 6 months.

Inclusion Criteria: * Adults ≥18 years. * Stroke ≥1 month previously. * Lower limb spasticity involving triceps surae (MAS ≥1+). * Able to walk with or without orthosis Exclusion Criteria: Fixed ankle contracture. * Botulinum toxin treatment within previous 6 months. * Progressive neurological disease. * Skin lesions or severe vascular disease affecting treatment area.