Tendon transfer in foot drop: a systematic review

Abstract

Introduction Foot drop is a disorder that impairs walking and leads to tripping and falling. Tendon transfer (e.g., tibialis posterior tendon) is a typical secondary procedure in foot drop treatment. The purpose of this systematic review was to identify the most common tendon transfer techniques for treating foot drop and to analyze the reported functional outcomes. Furthermore, it was of interest if the type of surgical technique affects the functional outcome. Methods A PubMed and MEDLINE literature search was performed according to PRISMA guidelines. The search terms used were (“tendon transfer” OR “tendon transposition”) AND (“foot drop” OR “peroneal neuropathies”). Any study published before January 2020 was considered for inclusion. No case reports or reviews were included. Common outcome measures (Stanmore score, AOFAS, FAAM, AFO use, patient satisfaction and active ankle dorsiflexion) were evaluated. The quality of the included studies was assessed using the Coleman Methodology Score. Results Of the 125 reviewed publications, 37 met the inclusion criteria. 42 cohorts were analyzed. The frequently reported tendon transfer technique was the tibialis posterior tendon transfer through the interosseus membrane. The most used fixation technique was tendon on tendon fixation; however in recent years, a tendon to bone fixation has gained popularity. There was an increase in Stanmore scores and AOFAS postoperatively and a decrease of AFO use postoperatively observed. Conclusions Due to various outcome measures and lack of preoperative assessment in the included studies, a meta-analysis of the pooled results was not possible. Nevertheless, the findings of this study show that tendon transfer increases mobility and self-independency leading to patient satisfaction. The choice of the surgical technique does not affect the outcome. A prospective collection of patient data and standardized outcome measures will be important to further analyze the efficacy of tendon transfer techniques.

Useful functional recovery and quality of life after surgical treatment of peroneal nerve injuries

“…Based on our results, we can hypothesize, that the origin of pain in our patients was not neuropathic in the majority, but rather chronic foot pain due to the instability and the arch flattening. The most dedicated foot drop inventories focus on the use of bracing as a main aim of the treatment, and the use of TT, rather than the functional recovery following nerve release or repair, and actual QoL (20,21,37). Although in a relatively small cohort, there were no statistically significant differences in the QoL scores between the three treatment options, suggesting that no surgical technique influences the QoL by itself, but rather the right approach allows to achieve a similar QoL.…”

“…Motor recovery is the most commonly measured outcome, and there are some tools to asses useful functional recovery and QoL, however, with some applicable limitations. Patients treated for lower extremity nerve injuries were rarely evaluated in light of QoL before, while the foot drop is usually evaluated in terms of QoL with a focus on the need for braces, most commonly with the Stanmore system ( 20 , 21 ).…”

Seltene Nervenkompressionssyndrome

“…Im Idealfall kann der Patient die Fußhebung wieder aktiv ansteuern. Die Langzeitergebnisse zeigen, dass in der Regel ein stabiler Einbeinstand möglich ist und auf eine lebenslange Schienenversorgung kann verzichtet werden kann 43 44 .…”

Muscle Architecture of Leg Muscles: Functional and Clinical Significance

“…When choosing an adequate muscle–tendon unit to be transferred, the treating physician has to ensure that the unit is expendable, meaning there must be another muscle–tendon unit that can perform the donor unit’s original function. The muscle–tendon unit being transferred should have adequate strength and excursion to be effective [ 4 ].…”