Triple Tendon Transfer for Correction of Foot Deformity in Common Peroneal Nerve Palsy

Background: Anterior transfer of posterior tibial tendon (PTT) is the most common technique to correct foot drop in patients with common peroneal nerve palsy. It does not address the loss of toe extension or “toe drop.” This may affect the gait pattern, and patients may not tolerate it. Described he...

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Bibliographic Details
Published in:Foot & ankle international 2016-06, Vol.37 (6), p.665-669
Main Author: Movahedi Yeganeh, Mohsen
Format: Article
Language:English
Subjects:
Ankle Joint - physiology
Foot Deformities - physiopathology
Foot Deformities - surgery
Humans
Peroneal Nerve - physiopathology
Peroneal Neuropathies - surgery
Range of Motion, Articular - physiology
Tendon Transfer - methods
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Summary:Background: Anterior transfer of posterior tibial tendon (PTT) is the most common technique to correct foot drop in patients with common peroneal nerve palsy. It does not address the loss of toe extension or “toe drop.” This may affect the gait pattern, and patients may not tolerate it. Described here is a technique that addresses toe drop associated with common peroneal nerve palsy. Method: A new technique of tendon transfer using the PTT, flexor hallucis longus (FHL) tendon, and flexor digitorum longus (FDL) tendon was performed on 15 patients (13 males and 2 females) with complete common peroneal nerve palsy from 2009 to 2013. Minimum follow-up was 12 months (range, 12-50 months). The mean age was 37 years (range, 20-52 years). Results: Based on the evaluation criteria of Carayon et al, the postoperative results for foot drop correction were excellent in 9 (60%), good in 5 (33%), and moderate in 1 (7%), and the mean active range of motion of the ankle was 46 degrees. Postoperative extension evaluation of the toes was excellent in 7 (47%), good in 5 (33%), and moderate in 3 (20%). Conclusion: Releasing and transferring of FDL and FHL to the toe extensors along with the anterior transfer of the PTT neutralized the deforming forces and allowed for active toe extension while strengthening ankle dorsiflexion. Movahedi Tendon Transfer was a reliable method to achieve a balanced foot and toe dorsiflexion for complete common peroneal nerve palsy. Level of Evidence: Level IV, retrospective case series.
ISSN:1071-1007
1944-7876
DOI:10.1177/1071100716629779