Drop foot after high tibial osteotomy: a prospective study of aetiological factors

Abstract

Drop foot is not uncommon after high tibial osteotomy for genu varum. The authors report their results of a prospective study of 16 patients operated on between May 1990 and May 1991. All patients had medial femoro-tibial osteoarthritis with a constitutional genu varum. They all had a subtraction valgus high tibial osteotomy fixed by a blade plate. The experimental protocol included clinical review, antero-lateral compartment pressure measurements, intra- and post-operative electromyography, assessment of the post-operative drainage, serum estimation of muscle enzymes and post-operative arteriography. From their own results and a literature review, the authors consider successively the different aetiological factors for post-operative drop foot. Certain deficits occur due to direct trauma on the nerve during high osteotomy of the fibula, by local high pressure due to poor haemostasis or ineffective drainage. In addition, there are several related phenomena. The pneumatic tourniquet sensitises the nerve to trauma, and stretching of the nerve during correction of the deformation depends on the local anatomical factors and their marked variation. In order to diminish the frequency of these post-operative complications, the authors suggest limiting the surgical approach, and limiting as far as possible the traumatic manoeuvres on the nerve by using a tibial resection jig, which allows correction without forced manoeuvres. Finally, the authors discuss the benefits of using a pneumatic tourniquet.

Recovery of ankle dorsiflexion weakness following lumbar decompressive surgery

“…Numerous case reports describe foot-drop in association with unusual aetiology, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] and the outcomes of operative management or rehabilitation for this disabling deficit have been described. [19][20][21][22] Some publications describe the natural history and patterns of neural compression in patients with ADF weakness due to lumbar compressive pathology and only a few articles specifically evaluate the recovery of ADF weakness after decompressive surgical intervention.…”

Bilateral foot drop: looking for the needle in the wrong haystack?

“…Pre-existing neuropathies have been identified as risk factors in nerve palsies. 4. Was the femur alone operated?…”

“…If they were also operated upon, the foot drop could be related to the surgery. 4 5. What was the position of the patient during surgery?…”

Complications of closing wedge high tibial osteotomy

“…Gibson et al [12] and Bauer et al [13], however, have shown that there is an increase in compartment pressures with this technique, leading to the possibility of an anterior compartment syndrome. Gibson et al [12] showed that there was significant elevation of the anterior compartment pressures to greater than 45 mmHg in the majority of the study group (7 out of 10) where the compartment was not drained, with five of them experiencing transient clinical signs.…”

“…The proximity of the nerve to the fibular head and neck is thought to be a causative factor as well as several other anatomical and surgical factors. Bauer et al [13] identified two direct factors that contributed to this complication, namely, direct trauma to the nerve secondary to a high fibular osteotomy and high compartment pressure due to poor haemostasis or inadequate drainage. They also identified two related factors: use of a tourniquet, which sensitises the nerve, and stretching of the nerve during correction of the deformity.…”