Presentation and management outcome of foot drop with tibialis posterior tendon transfer.

Abstract

Background: Foot drop causes considerable disability. The ankle-dorsiflexion is either weak or lost completely. Additionally, the ankle eversion and toe extensions are also impaired. This results in a high steppage gait while walking. Overall, the gait is awkward; there is greater energy consumption; increased proneness to sustain injury of the forefoot; and more frequent falling during walking.

Aim: To document the clinical and epidemiological profile of foot drop patients in our population and evaluate the outcome of tibialis posterior (TP) tendon transfer for restoring the lost dorsiflexion in foot drop.

Methods: The study was carried out at the National Institute of Rehabilitation Medicine in Islamabad over a period of 7 years. It included patients of all sexes and ages who presented with foot drop and had no contraindications for the procedure of TP tendon transfer. Exclusion criteria were patients who had contraindications for the operation. For instance, paralyzed posterior leg compartment muscles, Achilles tendon contracture, stiff ankle or toes, unstable ankle joint, weak gastrocnemius and scarred skin spanning over the route of planned tendon transfer. Also, patients who had the foot drop as a result of disc prolapses or brain diseases were excluded. Convenience sampling technique was used. The circum-tibial route of TP tendon transfer was employed.

Results: Out of 37 patients, 26 (70.27%) were males whereas 11 (29.72%) were females. The mean age was 22.59 ± 8.19 years. Among the underlying causes of foot drop, road traffic accidents constituted the most common cause, found among 20 (54.05%) patients. The share of complications included wound infections in 3 (8.10%) patients and hypertrophic scars in 2 (5.40%) patients. At 1-year postoperative follow-up visits, the outcome was excellent in 8 (21.62%), good in 20 (54.05%) and moderate in 9 (24.31%).

Conclusion: The majority of cases of foot drop resulted from road traffic accidents that directly involved the common peroneal nerve. TP tendon transfer through the circumtibial route was found to be an easily executed effective operation which restored good dorsiflexion of the ankle among the majority of patients.