Surgical reconstruction of leprotic foot-drop

Abstract

Summary We have operated on 25 patients for correction of foot-drop due to leprosy from March 1992 to July 1994. The method used was circumtibial transfer of the tibialis posterior to the tendons of extensor hellucis longus and the extensor digitorum longus in the fo ot together with lengthening of the Achilles tendon. The results were satisfactory in 20 of these cases as judged by adequate restoration of heel-toe gait and of active dorsiflexion. The follow-up period ranged from 6 months to 2 years. Inadequate post-operative physiotherapy was the reason for unsatisfactory results in five cases.It is well recognized that correction of fo ot-drop deformity in leprosy is essential to ensure normal walking and to prevent plantar ulcerations. This paper describes the procedure adopted and the results of surgical correction of fo ot-drop due to leprosy in 25 patients at the Leprosy Control Institute and Hospital, Mohakhali, Dhaka in Bangladesh. The procedure adopted was the transfer of the tendon of the tibialis posterior muscle to the extensor tendons of the toes in the fo ot so as to ensure active dorsiflexion of the fo ot. 1-3 Material and methodsIn the Institute between March 1992 and July 1994 we saw 34 patients with fo ot-drop due to leprosy. Nine of these were treated conservatively and 25 were treated surgically. Of these 25 patients 20 were male and 5 female. Their ages ranged fr om 12 to 45 years. Contracture of the Achilles tendon was present in all cases. The fo llow-up period was 6 months to 2 years.

Tibialis posterior transfer by interosseous route for the correction of foot drop in leprosy

“…Tibialis posterior transfer through the IO route with elongation of tendo Achilles can obtain excellent results in treating foot drop due to leprosy [2,5,9,10].…”

Double transfert tendineux pour pied tombant

“…D'autres techniques font appel à des fixations osseuses des transferts [2] ou à des arthrodèses complémentaires [5], ce qui peut faire l'objet de complications, de non-fixation et donc de lâchage de suture. D'autres techniques enfin utilisent la voie de transfert circumtibiale [3,12] qui risque de provoquer un varus résiduel du pied si le transfert du tibial postérieur est isolé. On peut faire le même reproche à la suture selon Pulvertaft [1,2].…”

“…Cependant, le temps osseux sur le tarse antérieur a été source d'échecs et de mauvais résultats et ce sont Carayon et al [11] à la même époque qui ont décrit une suture tendineuse en amont de la cheville. C'est celle que nous décrivons ici, avec les modifications apportées par tous les DOI chirurgiens qui en ont eu l'expérience au fil du temps, expérience acquise pour la plupart en zone d'endémie lépreuse après névrite aiguë non guérie du nerf péronier commun ou après injection dans la fesse d'antipaludéens [5,[12][13][14][15].…”

Dampak Rehabilitasi Medis pada Penyandang Disabilitas Kusta

“…Sementara pasien memperoleh hasil yang tidak memuaskan karena tidak menjalani fisioterapi secara adekuat. 8 Tidak semua penderita kusta yang sembuh dapat kembali bekerja pada pekerjaan semula, terutama penderita yang telah terlanjur mengalami cacat fisik. Walaupun telah menjalani rehabilitasi medis dan dinyatakan sembuh, penderita tidak dapat melakukan pekerjaan yang sama seperti sediakala.…”