title: Bridle procedure combined with a subtalar implant: a case series and review of the literature.
abstract: BACKGROUND
  The bridle procedure is a tritendon anastomosis between the tibialis posterior, peroneus longus, and tibialis anterior, utilized in the treatment of drop foot. Concerned about the potential for acquired flatfoot deformity following the bridle procedure, the authors hypothesized that placing a sinus tarsi implant would prevent this potential sequela.
  
  
  METHODS
  Over a 10-year period, 15 patients (16 feet) were treated with a bridle procedure for drop foot, and 9 of these feet also had a subtalar arthroereisis implanted; 8 patients (9 feet) positively responded to requests for long-term follow-up evaluation and returned for subjective evaluation with the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale and Short Form (SF)-36 forms and objective clinical and radiographic measurements.
  
  
  RESULTS
  At an average follow-up of 61 months, the 8 patients (9 feet) who returned for long-term evaluation maintained a plantigrade foot, were able to dorsiflex above neutral both actively and passively, and did not develop a flatfoot deformity at long-term follow-up. There were no significant differences between those who had a sinus tarsi implant (6 feet) and those who did not (3 feet). Although 7 of the 9 feet evaluated in this study wore a brace preoperatively, none continued to use a brace after surgery. The major complaints were occasional pain at the subtalar arthroereisis site and a feeling that the great toe was dragging.
  
  
  CONCLUSIONS
  The bridle procedure provided excellent outcomes in patients with drop foot, with patients achieving long-term success in being free from brace wear. The ability to actively dorsiflex the foot during gait was also restored, reestablishing a normal heel-to-toe gait pattern.
  
  
  METHODS
  Therapeutic, Level IV: Case series.
authors.affiliation: UPMC, Pittsburgh, Pennsylvania (JF)Vero Orthopaedics and Neurology, Vero Beach, Florida (AW)Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania (JB, PJ).
authors.forename: James
authors.initials: J
authors.lastname: Flynn
authors.affiliation: UPMC, Pittsburgh, Pennsylvania (JF)Vero Orthopaedics and Neurology, Vero Beach, Florida (AW)Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania (JB, PJ).
authors.forename: Allison
authors.initials: A
authors.lastname: Wade
authors.affiliation: UPMC, Pittsburgh, Pennsylvania (JF)Vero Orthopaedics and Neurology, Vero Beach, Florida (AW)Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania (JB, PJ).
authors.forename: Jorge
authors.initials: J
authors.lastname: Bustillo
authors.affiliation: UPMC, Pittsburgh, Pennsylvania (JF)Vero Orthopaedics and Neurology, Vero Beach, Florida (AW)Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania (JB, PJ) pjuliano@hmc.psu.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Juliano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004863:Equinus Deformity / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000601:surgery*; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013380:Subtalar Joint / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D055815:Young Adult
keywords: bridle; drop foot; equinus; foot drop; peroneal nerve palsy; sinus tarsi implant; subtalar arthroereisis; tendon transfer; tibialis posterior