The role of tibialis posterior tendon transfer in foot drop by circumtibial route and evaluation of the results according to criteria
Keywords:Tibialis posterior, Circumtibial, Carayon
Background: The transfer of the tibialis posterior tendon to the anterior aspect of the ankle not only replaces the function of the paralyzed muscles, but also removes the deforming force on the medial aspect of the foot. This study was conducted to find the role of tibialis posterior tendon transfer in foot drop by circumtibial route and with evaluation of the results according to criteria.
Methods: This study was conducted in MLB Medical College and Hospital, Jhansi. Patients of paralytic foot drop due to leprosy with a moderately strong tibialis posterior muscle were selected from the outpatient department of Orthopaedics and Leprosy reconstructive surgery units. After taking informed consent, detailed history was taken. Data was analyzed using Microsoft Excel and the difference was considered to be significant if ‘p’ value was <0.05.
Results: Eleven patients were operated. Majority were males (82%). Eight patients (73%) had excellent and good results which were aged less than forty years. Two cases showed excellent results after corrective surgery that had deformities from 31 to 36 months before operation. Out of six patients who were taking antileprotic treatment, one (9.1%) showed excellent and three (27.3%) showed good results.
Conclusions: Method of anterior transfer of tibialis posterior for correction of foot drop has given encouraging results in a fairly large percentage of cases. The greatest utility of such a transfer is that of allowing the freedom of normal mobility in comparison to bony stabilization. After correction of deformity and disability the patient’s mental health is improved.
Gilchrist RV, Bhagia SM, Lenrow DA, Chou LH, Chow D, Slipman CW. Painless foot drop: an atypical etiology of a common presentation. Pain Physician. 2002;5:419-21.
Rodriguez RP. The Bridle procedure in the treatment of paralysis of the foot. Foot Ankle 1992;13:63-9.
D’Astous JL, MacWilliams BA, Kim SJ, Bachus KN. Superficial versus deep transfer of the posterior tibialis tendon. J Pediatr Orthop. 2005;25:245-8.
Wiesseman GJ. Tendon transfers for peripheral nerve injuries of the lower extremity. Clin Orthop North Am. 1981;12:459-67.
Hove LM, Nilsen PT. Posterior tibial tendon transfer for drop- foot. 20 cases followed for 1-5 years. Acta Orthop Scand. 1998;69:608-10.
Carayon A, Bourrel P, Bourges M, Touze M. Dual transfer of the posterior tibial and flexor digitorumlongus tendons for Drop foot. Report of thirty-one cases. J Bone Joint Surg [Am]. 1967;49:144-8.
Lipscomb PR, Sanchez JJ. Anterior transplantation of the posterior tibial tendon for persistent palsy of the common peroneal nerve. J Bone Joint Surg [Am]. 1961;43:60-6.
Goh JC, Lee PY, Lee EH, Bose K. Biomechanical study on tibialis posterior tendon transfers. Clin Orthop Relat Res. 2011;(319):297-302.
Terranpva WA. McLaughlin RE, Morgan RF. An algorithm for the management of ligament injury of the knee associated with common peroneal nerve palsy. Orthopedic. 1986;11:35-40.
Pritchett JW, Porembski MA. Foot drop. Retrieved from Emedicine Medscape. Available at: http://emedicine.medscape.com/article/1234607-overview. Accessed on 17 May 2013.
Andersen JG. Foot drop in leprosy and its surgical correction. Acta Orthop Scand. 1963;33:151-71.
Richard BM. Interosseous transfer of tibialis posterior for common peroneal nerve palsy. J Bone Joint Surg [Br]. 1989;71:834-7.
Straub LR, Thompson TC, Arnold WD. Congenital absence of the fibula. J Bone and Joint Surg, 1957;39:1229-37.
Majeed GH, Mohammed S. Al- Iedani, Aaqail FM. The role of tibialis posterior tendon transfer in correction of foot dropdisformity. KCMJ 2013;9(2):86-9.
Gunn DR, Molesworth BD. The use of Tibialis posterior as a dorsiflexor. J Bone Joint Surg Br. 1957;39(4):674-8.
Yeap JS, Singh D, Birch R. A method for evaluating the results of tendon transfers for foot drop. Clin Orthop Relat Res. 2001;383:208-13.
Soares D. Tibialis posterior transfer in the correction of foot drop due to leprosy. Leprosy Rev. 1995;66:229-34.