Two-Tailed Transfer of Tibialis Posterior for Correction of Drop-Foot in Leprosy

Abstract

1. The results of thirty-nine operations for correction of drop-foot in thirty-three patients with leprosy are discussed. 2. The procedure used was circumtibial, subcutaneous, two-tailed, tendon-to-tendon transfer of the tibialis posterior to extensor hallucis longus and to extensor digitorum longus and peroneus tertius. The motor slips were inserted into the recipient tendons on the dorsum of the foot. 3. Analysis of the results showed some correlation between the angle of active dorsiflexion and the range ofactive movement ofthe ankle. The angle ofdorsiflexion seemed to determine the range of movement. 4. When contracture of the tendo calcaneus was present, simultaneous lengthening improved the angle of dorsiflexion more than the range of active movement. 5. The causes of failure were sepsis, failure of re-education and unrecognised tightness of the tendo calcaneus. 6. The advantages of the present procedure are mentioned.

New Tendon Transfer for Correction of Drop-foot in Common Peroneal Nerve Palsy

“…By creating a new ATT origin on the third cuneiform, we bring the recipient tendon directly up to the PTT solving tendon harvest length problems and preserving a straight line of pull. This has the potential to better preserve the strength of the transfer which other techniques may sacrifice when the PPT is split into two tails and sutured to other tendons [22,24,27,29].…”

“…We believe these good results could be related to the direct TtT suture performed between the ATT and PTT that produces straight traction at the third cuneiform strengthened by the associated transfer [3] of the FDL on the EDL-EHL tendons. Tendon to tendon suture, introduced in 1968 [24], simultaneously addresses the difficulties related to TtB procedures and donor tendon length. It allows the surgeon to adjust and modulate tendon tension, appropriately verifying foot and digit posture before suturing is completed [24] for the FDL on EDL-EHL tendons and the PTT on ATT.…”

“…Tendon to tendon suture, introduced in 1968 [24], simultaneously addresses the difficulties related to TtB procedures and donor tendon length. It allows the surgeon to adjust and modulate tendon tension, appropriately verifying foot and digit posture before suturing is completed [24] for the FDL on EDL-EHL tendons and the PTT on ATT. The technique also can be used for terminolateral and terminoterminal tendon suturing allowing multiple tendon reconstruction.…”

“…This technique has been widely used [6,13,17,22], becoming the most accepted reconstructive method to correct dropfoot [6]. This technique, however, has several disadvantages relating to insufficient length of the PTT after harvest preventing easy tendon-to-bone (TtB) insertion on the dorsal aspect of the foot often requiring the ankle to be maximally dorsiflexed or altering the plan of location or the method of tendon insertion [6,8,12,22,24,26,29].…”

“…Tendon-to-tendon (TtT) suturing has been described [3,8,17,22,24] as an alternative to the TtB procedure eliminating the need for screws, staples, or pullout wires tied over a button [12,26]. Direct TtT suture, however fails to achieve balanced dorsiflexion because the foot needs to be pulled medially (using anterior tibialis tendon [ATT] and/or extensor hallucis longus tendon [EHL]) and laterally (using the peroneus longus or tertius) using recipient tendons as reins [3,8,17,18,21,22,26,27,29].…”