Tibialis posterior transfer in the correction of footdrop due to leprosy

Abstract

SummaryIn the correction of fo otdrop due to leprosy neuritis the tibialis posterior muscle is re-routed and used to provide dorsiflexion of the fo ot. This study of tibialis posterior transfer was carried out to compare the results of the circumtibial and interosseous routes. There is no significant difference in the range of motion between either route though the range of the interosseous route is more functional (better dorsiflexion). The interosseous route is prefer able as this results in a significantly lower incidence of recurrent inversion deformity of the foot at long-term fo llow-up when compared with the circum tibial route.Footdrop due to the paralysis of the anterior tibial and peroneal muscles is found in 2-5 % 1 0,1 6 of newly diagnosed leprosy patients as a result of leprosy neuritis.Leprosy neuritis affects nerves where they are close to the skin and pass through a narrow fibro-osseous canal. In the lower limb this involves the lateral popliteal nerve around the neck of the fibula (leading to fo otdrop) and the posterior tibial nerve at the tarsal tunnel (leading to anaesthesia of the plantar surface). When both these nerves are damaged then the main impact during walking falls on the anaesthetic fo refoot rather than the heel, with plantar trophic ulceration being the almost inevitable result. This study assesses the outcome of tibialis posterior transfer (TPT) in the correction of fo otdrop due to leprosy and specifically compares the circumtibial (CT) with the interosseous (10) route. MethodsOne hundred and ten fo otdrop corrections in 95 patients (83 male and 12 female) on a total of 105 fe et were followed-up. These were performed in the years 1987-93. Ten patients had bilateral corrections. Nine operations were redone when the earlier operation had fa iled, i.e. the patient developed recurrent inversion or fo otdrop 0305-7518/95/066229 +06 $1.00 © Lepra 229

Posterior Tibial Tendon Transfer: Results of Fixation to the Dorsiflexors Proximal to the Ankle Joint

“…Others used too varying scoring systems to evaluate gait, some without defining the result clearly. 9,35,39 Active dorsiflexion to neutral or beyond was achieved in 9 of the 13 transfers with a median of 0 degrees, which is comparable to the literature regarding other techniques (50% to 95% reaching at least neutral, with an average of about -3.3 to 10 degrees, Tables 4 and 5). The median active plantarflexion and range of motion (both 40 degrees) also are similar to the results in the literature regarding other techniques (9 to 43 degrees and 17 to 40 degrees respectively, Tables 4 and 5).…”

“…Others used too varying scoring systems to evaluate gait, some without defining the result clearly. 9,35,39…”

Tibialis Posterior Tendon Transfer for Persistent Drop Foot after Peroneal Nerve Repair

“…19 In contrast, Soares's study shows that both methods yield above-neutral dorsiflexion in 80% of the patients, and from the viewpoint of dorsiflexion both methods are equally successful. 18 In our series, we did not face the problems previously described for the circumtibial route, such as foot inversion or cosmetic problems like the visibility of the tendon in the subcutaneous tunnel. In addition, the Andersen tendon carrier, owing to its blunt edge and curved body, facilitated easy transfer of the tendon anteriorly.…”

“…Soares used tendon-tendon insertion and reported that between the time of suture and discharge from the hospital, there would be a 10-degree decrease in dorsiflexion, and a further 5-to 10-degree decrease during follow-up. 18 Therefore he suggested suturing the tendons while the ankle is kept at 20 degrees of dorsiflexion to compensate for this decrease. During transfer, we keep the ankle at 20 to 30 degrees of dorsiflexion and the TP tendon tight.…”

Posterior Tibial Tendon Transfer with Combined Tendon-Tendon and Tendon-Bone Fixation using the Circum-Tibial Route and Superficial Retinacular Passage in the Foot Drop

“…In particular, tendon transfer has been shown to improve patient satisfaction by increasing mobility and walking independence. In the treatment of foot drop, tendon transfer over the interosseous membrane and tendon fixation to bone have been the preferred techniques in recent years [8][9][10]. In our case, we used combined tendon-totendon and tendon-to-bone fixation, preferring the circumferential route and the superficial retinacular passage.…”