Effectiveness of tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEN Xiaodong , ZHAO Hongmou , LU Jun , LI Yi , ZHANG Yan , LIANG Jingqi , CHANG Xin ,  LIANG Xiaojun

Department of Foot and Ankle Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

LIANG Xiaojun, Email: liangjun33369@163.com

Keywords：

Foot drop; tibialis posterior tendon; tendon transfer; peroneal nerve palsy; ankle joint

DOI：

10.7507/1002-1892.201909105

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Objective To investigate the effectiveness of tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy.Methods The clinical data of 21 patients with unilateral foot drop secondary to peroneal nerve palsy between October 2009 and September 2016 was retrospectively analyzed. There were 12 males and 9 females with an average age of 32.1 years (range, 23-47 years). The causes of peroneal nerve injury were iatrogenic injury in 7 cases, tibiofibular fractures combined with compartment syndrome in 5 cases, nerve exploration surgery after stab or cut injury in 3 cases, direct violence in 4 cases, and the fibular head fracture in 2 cases. The average time from injury to operation was 5.6 years (range, 2-8 years). There was 1 case of hallux valgus and 5 cases of toe flexion contracture. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, Foot and Ankle Ability Measure (FAAM) scores, range of motion (ROM), and dorsiflexion strength of ankle joint were used to evaluated the ankle function. Radiographic evaluation for the changes of postoperative foot alignment included Meary angle, calcaneal pitch angle, and hindfoot alignment angle.Results All incisions healed by first intention. All patients were followed up 18-42 months (mean, 30.2 months). The dorsiflexion strength of ankle joint recovered from grade 0 to grade 3-4 after operation. There was no patient with a postoperative flat foot deformity and claw toe during follow-up. There was no significant difference in Meary angle, calcaneal pitch angle, and hindfoot alignment angle between pre- and post-operation (P>0.05). The AOFAS score, FAAM score, and ROM of dorsiflexion significantly improved at last follow-up when compared with preoperative values (P<0.05); while there was no significant difference in ROM of plantar-flexion between pre- and post-operation (t=4.239, P=0.158). There were significant differences in AOFAS score, FAAM score, and ROM of dorsiflexion between affected and healthy sides (P<0.05); but no significant difference in ROM of plantar-flexion was found (t=2.319, P=0.538).Conclusion Tibialis posterior tendon transfer is an effective surgical option for foot drop secondary to peroneal nerve palsy. And no postoperative flat foot deformity occurred at short-term follow-up.

Citation： WEN Xiaodong, ZHAO Hongmou, LU Jun, LI Yi, ZHANG Yan, LIANG Jingqi, CHANG Xin, LIANG Xiaojun. Effectiveness of tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 591-595. doi: 10.7507/1002-1892.201909105 Copy

1.	Sturbois-Nachef N, Allart E, Grauwin MY, et al. Tibialis posterior transfer for foot dropdue to central causes: long-term hindfoot alignment. Orthop Traumatol Surg Res, 2019, 105(1): 153-158.
2.	Cho BK, Park KJ, Choi SM, et al. Functional outcomes following anterior transfer of the tibialis posterior tendon for foot drop secondary to peroneal nerve palsy. Foot Ankle Int, 2017, 38(6): 627-633.
3.	Dreher T, Wolf SI, Heitzmann D, et al. Tibialis posterior tendon transfer corrects the foot drop component of cavovarus foot deformity in Charcot-Marie-Tooth disease. J Bone Joint Surg (Am), 2014, 96(6): 456-462.
4.	Shane AM, Reeves CL, Cameron JD, et al. Posterior tibial tendon transfers. Clin Podiatr Med Surg, 2016, 33(1): 29-40.
5.	Vigasio A, Marcoccio I, Patelli A, et al. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res, 2008, 466(6): 1454-1466.
6.	Hsu JD, Hoffer MM. Posterior tibial tendon transfer anteriorly through the interosseous membrane: a modification of the technique. Clin Orthop Relat Res, 1978, 131: 202-204.
7.	Marsland D, Stephen JM, Calder T, et al. Strength of interference screw fixation to cuboid vs pulvertaft weave to peroneus brevis for tibialis posterior tendon transfer for foot drop. Foot Ankle Int, 2018, 39(7): 858-864.
8.	Krishnamurthy S, Ibrahim M. Tendon transfers in foot drop. Indian J Plast Surg, 2019, 52(1): 100-108.
9.	Xu J, Geng X, Muhammad H, et al. Posterior tibialis tendon transfer via the circumtibial route: a cadaveric limb analysis. J Orthop Surg Res, 2014, 9: 121.
10.	Hájek P, Pilný J, Vodová H, et al. Peroneal nerve palsy management by tibialis posterior muscle transposition-Anatomical and clinical study. Acta Chir Orthop Traumatol Cech, 2019, 86(6): 419-422.
11.	Wagner E, Wagner P, Zanolli D, et al. Biomechanical evaluation of circumtibial and transmembranous routes for posterior tibial tendon transfer for dropfoot. Foot Ankle Int, 2018, 39(7): 843-849.
12.	Thamphongsri K, Harnroongroj T, Jarusriwanna A, et al. How to harvest the greatest length of tibialisposteriortendonfor tendon transfer: Acadaveric study. Clin Anat, 2017, 30(8): 1083-1086.
13.	Mohsen MY. Triple tendon transfer for correction of foot deformity in common peroneal nerve palsy. Foot Ankle Int, 2016, 37(6): 665-669.
14.	Pecheva M, Devany A, Nourallah B, et al. Long-term follow-up of patients undergoingtibialisposteriortransfer: is acquired pes planus a complication? Foot (Edinb), 2018, 34: 83-89.
15.	Molund M, Engebretsen L, Hvaal K, et al. Posterior tibial tendon transfer improves function for foot drop after knee dislocation. Clin Orthop Relat Res, 2014, 472(9): 2637-2643.
16.	Schweitzer KM Jr, Jones CP. Tendon transfers for the drop foot. Foot Ankle Clin, 2014, 19(1): 65-71.
17.	Steinau HU, Tofaute A, Huellmann K, et al. Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements. Arch Orthop Trauma Surg, 2011, 131(7): 903-910.
18.	Aleksić M, Baščarevic Z, Stevanović V, et al. Modified split tendon transfer of posterior tibialis muscle in the treatment of spastic equinovarus foot deformity: long-term results and comparison with the standard procedure. Int Orthop, 2020, 44(1): 155-160.
19.	Johnson JE, Paxton ES, Lippe J, et al. Outcomes of the Bridle procedure for the treatment of foot drop. Foot Ankle Int, 2015, 36(11): 1287-1296.
20.	Gatskiy AA, Tretyak IB, Tretiakova AI, et al. Choosing the target wisely: partial tibial nerve transfer to extensor digitorum motor branches with simultaneous posterior tibial tendon transfer. Could this be a way to improve functional outcome and gait biomechanics? J Neurosurg, 2019, 1: 1-9.
21.	Barg A, Harris MD, Henninger HB, et al. Medial distal tibial angle: comparison between weightbearing mortise view and hindfoot alignment view. Foot Ankle Int, 2012, 33(8): 655-661.
22.	Wang B, Saltzman CL, Chalayon O, et al. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis? Clin Orthop Relat Res, 2015, 473(1): 318-325.

1. Sturbois-Nachef N, Allart E, Grauwin MY, et al. Tibialis posterior transfer for foot dropdue to central causes: long-term hindfoot alignment. Orthop Traumatol Surg Res, 2019, 105(1): 153-158.
2. Cho BK, Park KJ, Choi SM, et al. Functional outcomes following anterior transfer of the tibialis posterior tendon for foot drop secondary to peroneal nerve palsy. Foot Ankle Int, 2017, 38(6): 627-633.
3. Dreher T, Wolf SI, Heitzmann D, et al. Tibialis posterior tendon transfer corrects the foot drop component of cavovarus foot deformity in Charcot-Marie-Tooth disease. J Bone Joint Surg (Am), 2014, 96(6): 456-462.
4. Shane AM, Reeves CL, Cameron JD, et al. Posterior tibial tendon transfers. Clin Podiatr Med Surg, 2016, 33(1): 29-40.
5. Vigasio A, Marcoccio I, Patelli A, et al. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res, 2008, 466(6): 1454-1466.
6. Hsu JD, Hoffer MM. Posterior tibial tendon transfer anteriorly through the interosseous membrane: a modification of the technique. Clin Orthop Relat Res, 1978, 131: 202-204.
7. Marsland D, Stephen JM, Calder T, et al. Strength of interference screw fixation to cuboid vs pulvertaft weave to peroneus brevis for tibialis posterior tendon transfer for foot drop. Foot Ankle Int, 2018, 39(7): 858-864.
8. Krishnamurthy S, Ibrahim M. Tendon transfers in foot drop. Indian J Plast Surg, 2019, 52(1): 100-108.
9. Xu J, Geng X, Muhammad H, et al. Posterior tibialis tendon transfer via the circumtibial route: a cadaveric limb analysis. J Orthop Surg Res, 2014, 9: 121.
10. Hájek P, Pilný J, Vodová H, et al. Peroneal nerve palsy management by tibialis posterior muscle transposition-Anatomical and clinical study. Acta Chir Orthop Traumatol Cech, 2019, 86(6): 419-422.
11. Wagner E, Wagner P, Zanolli D, et al. Biomechanical evaluation of circumtibial and transmembranous routes for posterior tibial tendon transfer for dropfoot. Foot Ankle Int, 2018, 39(7): 843-849.
12. Thamphongsri K, Harnroongroj T, Jarusriwanna A, et al. How to harvest the greatest length of tibialisposteriortendonfor tendon transfer: Acadaveric study. Clin Anat, 2017, 30(8): 1083-1086.
13. Mohsen MY. Triple tendon transfer for correction of foot deformity in common peroneal nerve palsy. Foot Ankle Int, 2016, 37(6): 665-669.
14. Pecheva M, Devany A, Nourallah B, et al. Long-term follow-up of patients undergoingtibialisposteriortransfer: is acquired pes planus a complication? Foot (Edinb), 2018, 34: 83-89.
15. Molund M, Engebretsen L, Hvaal K, et al. Posterior tibial tendon transfer improves function for foot drop after knee dislocation. Clin Orthop Relat Res, 2014, 472(9): 2637-2643.
16. Schweitzer KM Jr, Jones CP. Tendon transfers for the drop foot. Foot Ankle Clin, 2014, 19(1): 65-71.
17. Steinau HU, Tofaute A, Huellmann K, et al. Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements. Arch Orthop Trauma Surg, 2011, 131(7): 903-910.
18. Aleksić M, Baščarevic Z, Stevanović V, et al. Modified split tendon transfer of posterior tibialis muscle in the treatment of spastic equinovarus foot deformity: long-term results and comparison with the standard procedure. Int Orthop, 2020, 44(1): 155-160.
19. Johnson JE, Paxton ES, Lippe J, et al. Outcomes of the Bridle procedure for the treatment of foot drop. Foot Ankle Int, 2015, 36(11): 1287-1296.
20. Gatskiy AA, Tretyak IB, Tretiakova AI, et al. Choosing the target wisely: partial tibial nerve transfer to extensor digitorum motor branches with simultaneous posterior tibial tendon transfer. Could this be a way to improve functional outcome and gait biomechanics? J Neurosurg, 2019, 1: 1-9.
21. Barg A, Harris MD, Henninger HB, et al. Medial distal tibial angle: comparison between weightbearing mortise view and hindfoot alignment view. Foot Ankle Int, 2012, 33(8): 655-661.
22. Wang B, Saltzman CL, Chalayon O, et al. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis? Clin Orthop Relat Res, 2015, 473(1): 318-325.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy

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