title: Kinetics and kinematics after the Bridle procedure for treatment of traumatic foot drop.
abstract: BACKGROUND
  The Bridle procedure restores active ankle dorsiflexion through a tri-tendon anastomosis of the tibialis posterior, transferred to the dorsum of the foot, with the peroneus longus and tibialis anterior tendon. Inter-segmental foot motion after the Bridle procedure has not been measured. The purpose of this study is to report kinetic and kinematic variables during walking and heel rise in patients after the Bridle procedure.
  
  
  METHODS
  18 Bridle and 10 control participants were studied. Walking and heel rise kinetic and kinematic variables were collected and compared using an ANOVA.
  
  
  RESULTS
  During walking the Bridle group, compared with controls, had reduced ankle power at push-off [2.3 (SD 0.7) W/kg, 3.4 (SD 0.6) W/kg, respectively, P<.01], less hallux extension during swing [-13 (SD 7)°, 15 (SD 6)°, respectively, P<.01] and slightly less ankle dorsiflexion during swing [6 (SD 4)°, 9 (SD 2)°, respectively, P=.03]. During heel rise the Bridle group had 4 (SD 6)° of forefoot on hindfoot dorsiflexion compared to 8 (SD 3)° of plantarflexion in the controls (P<.01).
  
  
  CONCLUSIONS
  This study provides evidence that the Bridle procedure restores the majority of dorsiflexion motion during swing. However, plantarflexor function during push-off and hallux extension during swing were reduced during walking in the Bridle group. Abnormal mid-tarsal joint motion, forefoot on hindfoot dorsiflexion instead of plantarflexion, was identified in the Bridle group during the more challenging heel rise task. Intervention after the Bridle procedure must maximize ankle plantarflexor function and midfoot motion should be examined during challenging tasks.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA. hastingsmk@wustl.edu
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hastings
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
authors.forename: James
authors.initials: J
authors.lastname: Woodburn
authors.forename: E Scott
authors.initials: ES
authors.lastname: Paxton
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Klein
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: McCormick
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Bohnert
authors.forename: Krista S
authors.initials: KS
authors.lastname: Beckert
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Stein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Strube
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D000842:Ankle / Q000503:physiopathology; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D005260:Female; D005534:Foot Diseases / Q000503:physiopathology* / Q000601:surgery*; D005545:Forefoot, Human / Q000503:physiopathology; D006365:Heel / Q000503:physiopathology*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D010543:Peroneal Nerve / Q000293:injuries*; D012189:Retrospective Studies; D012584:Sciatic Nerve / Q000293:injuries*; D013710:Tendons / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D016138:Walking