Title: Foot Drop: Comparison of two Surgical Techniques for a Neglected Clinical Entity
Author: Dr Sumit Singhal MS, MCh (Plastic Surg)
DOI: https://dx.doi.org/10.18535/jmscr/v7i8.155
Abstract
Foot Drop is a quite common clinical entity. Various causes are responsible for the foot drop. The common peroneal nerve is the most commonly injured nerve in the lower limb. There is a long list of causes for the foot drop from central causes like stroke to Leprosy to isolated lesion of common peroneal nerve. The various treatment modalities like conservative splint management, steroid therapy, nerve repair or decompression, arthrodesis and others. Outcome of these and in particular of nerve repair is very uncertain. Also these cases come very late after roaming here and there to Plastic Surgeons when only tendon transfer is the treatment option. Here I describe surgical technique of Tibialis tendon transfer with two methods and their outcome comparison. From Jan. 2012 to June 2019, a total of 18 reluctant chronic neglected cases of foot drop were operated. Main reason for foot drop was traumatic peroneal in RTA. Proper pre operative evaluation was very important. All cases were operated under unilateral spinal anesthesia. Only two incisions were given, one to retrieve Tibialis posterior tendon and one for tendonorrhaphy. First 6 cases were operated with easy circum tibial subcutaneous route. In later 12 cases trans interosseous membrane route was preferred as it is more anatomically and physiologically near to normal force vectors. Operation usually took 60-80 min. Posterior slab is must for minimum 6 weeks and for next 6 weeks foot drop splint was given. This followed by proper physiotherapy and gait training. Results were almost same in both groups but patient satisfaction and foot position was better in trans interosseous group.
Keywords: Foot drop, tendon transfer, tibialis posterior, tibialis anterior, extensor hallucis longus.
