title: Early active motion versus immobilization after tendon transfer for foot drop deformity: a randomized clinical trial.
abstract: BACKGROUND
  Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout.
  
  
  OBJECTIVE
  To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems.
  
  
  METHODS
  We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups.
  
  
  RESULTS
  We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups.
  
  
  CONCLUSIONS
  In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking.
  
  
  METHODS
  Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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: Henk J
authors.initials: HJ
authors.lastname: Stam
authors.forename: Steven E R
authors.initials: SE
authors.lastname: Hovius
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Selles
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D002370:Casts, Surgical; D004434:Early Ambulation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D007918:Leprosy / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery; D008297:Male; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012149:Restraint, Physical; D013709:Tendon Transfer / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult
references.citation: Clin Orthop Relat Res. 2001 Feb;(383):208-13
references.pmid: 11210956
references.citation: Phys Ther. 2008 Jan;88(1):22-32
references.pmid: 17986495
references.citation: J Plast Reconstr Aesthet Surg. 2010 Mar;63(3):554-60
references.pmid: 19230819
references.citation: J Bone Joint Surg Br. 1989 Nov;71(5):834-7
references.pmid: 2555372
references.citation: J Hand Surg Am. 2001 Nov;26(6):1111-5
references.pmid: 11721260
references.citation: Foot Ankle Int. 2007 Nov;28(11):1128-42
references.pmid: 18021581
references.citation: J Bone Joint Surg Br. 1996 Jan;78(1):61-2
references.pmid: 8898128
references.citation: J Hand Surg Br. 1995 Jun;20(3):291-300
references.pmid: 7561400
references.citation: Clin Orthop Relat Res. 2008 Jun;466(6):1454-66
references.pmid: 18414961
references.citation: Lepr Rev. 2008 Jun;79(2):154-61
references.pmid: 18711937
references.citation: J Bone Joint Surg Br. 1968 Aug;50(3):629-34
references.pmid: 5726914
references.citation: J Bone Joint Surg Br. 1956 Feb;38-B(1):175-94
references.pmid: 13295327
references.citation: J Hand Surg Am. 2006 May-Jun;31(5):754-9
references.pmid: 16713838
references.citation: J Hand Surg Am. 2008 Feb;33(2):232-40
references.pmid: 18294546
references.citation: J Bone Joint Surg Br. 1968 Aug;50(3):623-8
references.pmid: 5726913
references.citation: J Hand Surg Am. 2009 Mar;34(3):488-94, 494.e1-5
references.pmid: 19258147