title: Early postoperative active mobilisation versus immobilisation following tibialis posterior tendon transfer for foot-drop correction in patients with Hansen's disease.
abstract: After tibialis posterior tendon transfer surgery for foot-drop correction, the foot is traditionally immobilised for several weeks. To test the feasibility of early mobilisation after this procedure in patients with Hansen's disease, 21 consecutive patients received active mobilisation of the transfer starting on the 5th postoperative day. Transfer insertion strength was enhanced by Pulvertaft weave. The results were compared with a historical cohort of 21 patients receiving 4 weeks of immobilisation. The primary outcomes were active dorsiflexion, active plantar flexion and total active motion at the ankle, tendon-insertion pullout and time until discharge from rehabilitation with independent walking without aid. Assessments at discharge from rehabilitation and the last clinical follow-up at more than 1 year were compared between both groups. The Student's t-test was used to compare data between the groups, and 95% confidence interval of the difference between groups was determined. A p-value of 0.05 was considered statistically significant. The average follow-up was 22 months for both groups. There was no incidence of insertion pullout of the tendon transfer in either group. In addition, there was no difference in active dorsiflexion angle between the groups at discharge (mean difference: 2.2 degrees, p=0.22) and final assessment (mean difference: 2.3 degrees, p=0.42). The plantar flexion angles were similar in both groups at discharge (mean difference: 0.5 degrees, p=0.86) and final assessment (mean difference: 0.5 degrees, p=0.57). In addition, there was no difference in total active motion between the groups at discharge (mean difference: 2 degrees, p=0.54) and final assessment (mean difference: 1 degrees, p=0.49). The patients were discharged from rehabilitation with independent walking at 44.04+/-7.9 days after surgery in the mobilisation group compared to 57.07+/-2.3 days in the immobilisation group. This indicates a significant difference in morbidity (mean difference: 13 days, p<0.001) between the two groups. In summary, this feasibility study indicates that early active mobilisation of tibialis posterior transfer in patients with Hansen's disease is safe and has similar outcomes to immobilisation with a reduced time to independent walking, warranting the design of a controlled clinical trial to further substantiate this.
authors.affiliation: LEPRA Funded Leprosy Reconstructive Surgery Unit HOINA, Muniguda, Orissa, India. handsurgery.rath@gmail.com
authors.forename: Santosh
authors.initials: S
authors.lastname: Rath
authors.forename: Ton A R
authors.initials: TA
authors.lastname: Schreuders
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Selles
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004434:Early Ambulation; D005240:Feasibility Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D007103:Immobilization; D007918:Leprosy / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D013709:Tendon Transfer; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult