Classic and Modified Barr’s Technique of Anterior Transfer of the Tibialis Posterior Tendon in Irreparable Peroneal Palsies

Abstract

Peroneal palsy with loss of active dorsal flexion in foot can be surgically treated by anterior transfer of tibialis posterior tendon. Two techniques are available, classic and modified Barr's technique of the anterior transfer of tibialis posterior tendon, with different place of tendon's reinsertion. The aim of the study is evaluation of the degree of active dorsal flexion in foot, and appearance of varus position and hipercorrection of the foot, by comparing the results of the two operative techniques. The study included 40 patients with peroneal irreparable palsies, divided into two equally sized groups. The first group was treated by classic Barr's technique. The other group of patients was treated by modified Barr's technique. The group treated by modified Barr's technique exhibited better functional results. Active dorsal flexion achieved between 950 (in 35% cases) and 900 (in 50% cases), while varus position and hipercorrection of the foot were absent. In the second group of 20 patients, treated by classic Barr's technique, 800 (40%) and 900 (25%) of active dorsal flexion, indicated worse functional postoperative results. Active dorsal flexion of 700 achieved by this method in two cases (10%), represents unsatisfactory functional result. Varus position of the foot was recorded in 5 cases (25%) and hipercorrection in 4 cases (20%). Modified Barr's technique is surgical method with better functional and postoperative results in treatment of irreparable peroneal palsy.

Tendon transfer for dysfunction of all tendons in leg excepting Achilles tendon and plantaris tendon following irreparable sciatic nerve palsy – A case report

“…Several tendon transfer procedures had been employed to treat foot drop due to irreparable peroneal nerve palsy. Anterior transfer of the tibialis posterior tendon transfer was preferred by many authors and several modifications and improvements had been made to the original technique [2] , [3] , [4] , [5] , [6] , [7] . Split tendon transfer of the tibialis posterior tendon for treatment of patients with extensive disruption of the tibialis anterior tendon was recommended [8] , [9] .…”

Tibialis Posterior Tendon Transfers to Correct Bilateral Postburn Ankle Equinus

“…The patient regained power and range of motion to both ankles, enabling her to self-mobilize. Although bilateral simultaneous release of foot contractures would likely lead to better postoperative outcomes, 3,5,6 this was a novel approach to postburn equinus in a poorly compliant patient. Follow-up at 3 years after reconstruction suggests that this technique is effective and long-lasting.…”

Tendon Transfers in Foot Drop

“…32 Modification of Barr's procedure, fixing the tendon to the cuboid bone, according to Salihagić et al produced much better result than the classic Barr's procedure. 33 Ober fixed the tendon to the base of the third metatarsal bringing it circumtibially. 29 Stable fixation to the bone requires pull-out wire sutures, staples, or bone anchor.…”