Background
The purpose of this study was to determine the clinical outcomes and objective measures of function that can be expected for patients following the Bridle procedure (modification of the posterior tibial tendon transfer) for the treatment of foot drop.
Methods
Nineteen patients treated with a Bridle procedure and 10 matched controls were evaluated. The Bridle group had preoperative and two year postoperative radiographic foot alignment measurements and completion of the Foot and Ankle Ability Measure (FAAM). At followup both groups were tested with the star-excursion test for standing balance, ankle plantarflexion and dorsiflexion isokinetic strength and the AOFAS and Stanmore outcome measures were collected only on the Bridle patients.
Results
There was no change in the radiographic foot alignment measures from pre- to postoperative. FAAM subscales of activities of daily living and sport, AOFAS and Stanmore scores were all reduced in Bridle patients compared to controls. Single limb standing balance reaching distance in the anterolateral and posterolateral directions were reduced in Bridle participants compared to controls (p<.03). Isokinetic ankle dorsiflexion and plantarflexion strength was lower in Bridle participants (2 ± 4 ft*lbs, 44± 16 ft*lbs) compared to controls (18± 13 ft*lbs, 65 ± 27 ft*lbs, p<.02). All Bridle participants reported excellent to good outcomes and would repeat the operation. No patient wore an ankle foot orthosis (AFO) for everyday activities.
Conclusion
The Bridle procedure is a successful surgery that does not restore normal strength and balance to the foot and ankle but allows individuals with foot drop and a functional tibialis posterior muscle to have significantly improved outcomes and discontinue the use of an AFO. In addition, there is no indication that loss of the normal function of the tibialis posterior muscle results in change in foot alignment 2 years after surgery.
Level of Evidence
III
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