Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements.
BACKGROUND
Drop foot deformity is a common problem with severe restrictions in quality of life and impairment of daily activities. A technique of posterior tibial tendon transfer through the interosseus membrane and fixation to the anterior tibial and the long peroneal tendon "Bridle procedure" (stirrup-plasty) offers a physiological alternative to surgical correction.


METHODS
Data of 53 consecutive patients treated by stirrup-plasty were acquired from patient's charts; 31 were interviewed with standardized questionnaires; 20 were examined physically; 19 received pedobarography, and 8 underwent dynamometric muscle function tests. Follow-up time averaged 6.5 years.


RESULTS
The mean range of motion (ROM) in the ankle joint was 8° dorsiflexion and 15° plantar flexion. Most patients achieved plantigrade foot position and the majority developed gait without orthotic devices. As expected, maximum dorsiflexion torque averaged a third of the non-operated leg, according to reduced muscle diameter and strength of the transferred muscle. Pressure distribution of the sole during gait was not relevantly altered by the tendon transfer compared to the non-operated leg. Most patients were satisfied with the operative results and reported a significant increase in quality of life.


CONCLUSIONS
Fusion of the transposed posterior tibial, anterior tibial and the peroneus longus tendon prevents drop foot deformity sufficiently. The stirrup mechanism, in combination with tenodesis of the toe extensors, provides a balanced foot and avoids equinovarus and cavus deformity without immobilizing the ankle joint. Improvements in quality of life parameters justify the risk of the operative procedure for the patient.
Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. hans-ulrich.steinau@bergmannsheil.de
Hans-Ulrich
HU
Steinau
Alexandra
A
Tofaute
Kathrin
K
Huellmann
Ole
O
Goertz
Marcus
M
Lehnhardt
Jessica
J
Kammler
Lars
L
Steinstraesser
Adrien
A
Daigeler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000175:diagnosis / Q000601:surgery*; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D053581:Muscle Strength Dynamometer; D020427:Peroneal Neuropathies / Q000503:physiopathology / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013709:Tendon Transfer / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult