Posterior Tibial Tendon Transfer to the Dorsal Foot

Drop Foot Correction

Edited by Michael Shereff, MD

Indications

This procedure is performed if the muscles and tendons that normally pass in front of the ankle and lift the foot up are weak or non-functioning (Drop Foot). Often this condition can be treated with bracing, but in patients who desire increased function or who cannot tolerate bracing, this procedure may be of significant benefit. A common cause of a drop foot is the loss of muscle function in the front of the lower leg due to compartment syndrome or peroneal nerve injury. In addition, conditions that cause selective or generalized nerve or muscle weakness, such as Charcot-Marie-Tooth disease, muscular dystrophy, or stroke, may develop loss of power of the anterior compartment muscles and benefit from this procedure.

Procedure

This procedure is performed through three incisions. The muscle-tendon which normally turns the foot inward and downward is rerouted. The tendon is detached from the inside of the foot and passed from the back to the front of the leg. It is then re-anchored to the top of the foot where it serves to hold the foot up during the swing phase of gait.

Recovery

To allow the tendon transfer to heal, the patient will need six weeks in a cast boot without weight bearing. They will then require another four to six weeks of physical therapy and retraining. Patients will achieve approximately 75% of their recovery in the first six months, as they work to regain the lost muscle strength. It is often longer than a year after surgery before the patient achieves their maximal improvement.

Complications

The usual potential risks of surgery are present with this operation, including the risk of:

• Infection
• Wound healing problems
• Blood clots
• Pulmonary Embolism
• Nerve irritation or injury

Potential complications that are specific to this procedure include:

• Failure of the tendon transfer: The transferred tendon could fail by pulling apart after it is loaded.
• Loss of muscle strength: Weakness of the tendon transfer will occur because transferred tendons automatically lose some strength.
• Persistent gait asymmetry: This procedure is designed to improve a patient’s gait, and hopefully allow patients to go without a brace. However, it will not produce a symmetrical gait and this can lead to symptoms elsewhere (ex. low back)

 

 

Edited October 5, 2019

mf/ 11.29.18