Foot & Ankle International - June 2017 - 632
632
tendon adhesion under the extensor retinaculum, secure
tendon-to-bone fixation, and appropriate rehabilitation at 6
weeks postoperation for tendon mobilization are the essential components.
An iatrogenic collapse of the medial longitudinal arch has
been a major concern in complete loss of TP tendon function, which may cause an increased calcaneal eversion and
decreased plantarflexion of the forefoot.17 Although adultacquired flatfoot deformity following TP tendon transfer has
been reported,12,18 these are limited to a few case reports.
The posterior tibial split tendon transfer to correct a varus
hindfoot deformity was reported to have the advantage in a
younger patient of minimizing the chance of a postoperative
flatfoot deformity.13 Mizel et al9 reported that no collapse of
the medial longitudinal arch and valgus hindfoot deformity
were found at an average follow-up of 74.9 months after TP
tendon transfer. Recently, Johnson et al6 reported there was
no indication that loss of the normal function of the tibialis
posterior muscle resulted in change in static stance foot
alignment 2 years after the Bridle procedure (modification
of the TP tendon transfer). Despite a concern regarding
adverse effects following complete sacrificing of the TP tendon, the present study also demonstrated no definitive radiographic nor clinical progression to postoperative flatfoot
deformity at intermediate-term follow-up. Because the
effects of TP tendon transfer on occurrence of an acquired
flatfoot or pes planovalgus deformity remain debatable,19-21
further long-term studies are needed to determine the risk of
loss of arch height after this procedure.
Omer11 reported that full active dorsiflexion is rarely
restored by TP tendon transfer alone. Because a transferred
muscle usually loses one grade of strength,1 full recovery of
dorsiflexion strength may be difficult despite a long period
of rehabilitation. Yeap et al20 reported that the torque generated by the transferred TP tendon for foot drop was about
30% compared to normal contralateral side, although 11 of
12 patients achieved clinically grade 4 or 5 muscle power of
dorsiflexion. Johnson et al6 also reported that patients had
only 18% of peak torque compared to the normal contralateral side after the Bridle procedure (tri-tendon anastomosis
of the peroneus longus, anterior and posterior tibial tendons). In the present study, a manual power grade of ankle
dorsiflexors significantly improved from a mean of 1.1 preoperatively to 3.9 at final follow-up. Mean peak torque (in
60 degrees/sec angular velocity) of dorsiflexors was 7.1 Nm
at final follow-up, which indicated that postoperative restoration of dorsiflexion strength was about 33% compared to
the control group, and 34.6% compared with the contralateral side. Despite incomplete dorsiflexion power, function
in daily activities and gait ability were satisfactorily
improved. All patients demonstrated the ability to dorsiflex
the foot during the swing phase, and only 1 patient (5.9%)
needed an ankle-foot orthosis for occupational activity.
Foot & Ankle International 38(6)
Whether the tendon transferred to another site can provide an active substitution for weak muscles or role of
tenodesis to dynamically fix a joint has always been a matter of concern.2,16,20 In terms of postoperative function, the
active substitution is known to be superior to a simple
tenodesis, because tenodesis would limit activities that
require a wide ROM and a fast switch from extension to
flexion of the involved joint.2 In a recent study regarding
the 3-dimensional gait analysis after TP tendon transfer to
correct footdrop, Dreher et al2 reported that TP tendon
transfer works as an active substitution, not as a tenodesis.
Although passive plantarflexion was not limited after surgery, active plantarflexion at push-off was significantly
reduced. Patients in the present study also showed a similar pattern of ROM limitation during the early postoperative period. However, we could identify the gradually
increasing active plantarflexion with improvement of calf
muscle weakness after muscle strengthening rehabilitation
and gait training.
The limitations of our study are as follows. First, physical examination including assessment of the ROM, manual
strength testing of all relevant musculotendinous units, and
sensory evaluation was performed only by the corresponding author. Therefore, we could not be completely convinced of the accuracy of physical examination, because the
reliability (verification of intraobserver reproducibility)
was not assessed. Second, this study included no objective
gait analysis. Dynamic EMG information during the entire
gait may have supported our conclusion that an out-ofphase tendon transfer became in-phase after surgical treatment and rehabilitation, as evidenced by active ankle
dorsiflexion during the swing phase of gait.
Conclusion
Anterior transfer of the tibialis posterior tendon appears to
be an effective surgical option for paralytic footdrop secondary to peroneal nerve palsy. Although restoration of dorsiflexion strength postoperatively was about 33% of a
normal ankle, function in daily activities and gait ability
were satisfactorily improved. In addition, tibialis posterior
tendon transfer demonstrated no definitive radiographic nor
clinical progression to postoperative flatfoot deformity at
intermediate-term follow-up.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Table of Contents for the Digital Edition of Foot & Ankle International - June 2017
Contents
Foot & Ankle International - June 2017 - Intro
Foot & Ankle International - June 2017 - Cover1
Foot & Ankle International - June 2017 - Cover2
Foot & Ankle International - June 2017 - i
Foot & Ankle International - June 2017 - ii
Foot & Ankle International - June 2017 - Contents
Foot & Ankle International - June 2017 - iv
Foot & Ankle International - June 2017 - v
Foot & Ankle International - June 2017 - vi
Foot & Ankle International - June 2017 - vii
Foot & Ankle International - June 2017 - viii
Foot & Ankle International - June 2017 - 1A
Foot & Ankle International - June 2017 - 1B
Foot & Ankle International - June 2017 - ix
Foot & Ankle International - June 2017 - x
Foot & Ankle International - June 2017 - xi
Foot & Ankle International - June 2017 - xii
Foot & Ankle International - June 2017 - 2A
Foot & Ankle International - June 2017 - 2B
Foot & Ankle International - June 2017 - xiii
Foot & Ankle International - June 2017 - xiv
Foot & Ankle International - June 2017 - xv
Foot & Ankle International - June 2017 - xvi
Foot & Ankle International - June 2017 - 3A
Foot & Ankle International - June 2017 - 3B
Foot & Ankle International - June 2017 - xvii
Foot & Ankle International - June 2017 - xviii
Foot & Ankle International - June 2017 - xix
Foot & Ankle International - June 2017 - xx
Foot & Ankle International - June 2017 - xxi
Foot & Ankle International - June 2017 - xxii
Foot & Ankle International - June 2017 - 589
Foot & Ankle International - June 2017 - 590
Foot & Ankle International - June 2017 - 591
Foot & Ankle International - June 2017 - 592
Foot & Ankle International - June 2017 - 593
Foot & Ankle International - June 2017 - 594
Foot & Ankle International - June 2017 - 595
Foot & Ankle International - June 2017 - 596
Foot & Ankle International - June 2017 - 597
Foot & Ankle International - June 2017 - 598
Foot & Ankle International - June 2017 - 599
Foot & Ankle International - June 2017 - 600
Foot & Ankle International - June 2017 - 601
Foot & Ankle International - June 2017 - 602
Foot & Ankle International - June 2017 - 603
Foot & Ankle International - June 2017 - 604
Foot & Ankle International - June 2017 - 605
Foot & Ankle International - June 2017 - 606
Foot & Ankle International - June 2017 - 607
Foot & Ankle International - June 2017 - 608
Foot & Ankle International - June 2017 - 609
Foot & Ankle International - June 2017 - 610
Foot & Ankle International - June 2017 - 611
Foot & Ankle International - June 2017 - 612
Foot & Ankle International - June 2017 - 613
Foot & Ankle International - June 2017 - 614
Foot & Ankle International - June 2017 - 615
Foot & Ankle International - June 2017 - 616
Foot & Ankle International - June 2017 - 617
Foot & Ankle International - June 2017 - 618
Foot & Ankle International - June 2017 - 619
Foot & Ankle International - June 2017 - 620
Foot & Ankle International - June 2017 - 621
Foot & Ankle International - June 2017 - 622
Foot & Ankle International - June 2017 - 623
Foot & Ankle International - June 2017 - 624
Foot & Ankle International - June 2017 - 625
Foot & Ankle International - June 2017 - 626
Foot & Ankle International - June 2017 - 627
Foot & Ankle International - June 2017 - 628
Foot & Ankle International - June 2017 - 629
Foot & Ankle International - June 2017 - 630
Foot & Ankle International - June 2017 - 631
Foot & Ankle International - June 2017 - 632
Foot & Ankle International - June 2017 - 633
Foot & Ankle International - June 2017 - 634
Foot & Ankle International - June 2017 - 635
Foot & Ankle International - June 2017 - 636
Foot & Ankle International - June 2017 - 637
Foot & Ankle International - June 2017 - 638
Foot & Ankle International - June 2017 - 639
Foot & Ankle International - June 2017 - 640
Foot & Ankle International - June 2017 - 641
Foot & Ankle International - June 2017 - 642
Foot & Ankle International - June 2017 - 643
Foot & Ankle International - June 2017 - 644
Foot & Ankle International - June 2017 - 645
Foot & Ankle International - June 2017 - 646
Foot & Ankle International - June 2017 - 647
Foot & Ankle International - June 2017 - 648
Foot & Ankle International - June 2017 - 649
Foot & Ankle International - June 2017 - 650
Foot & Ankle International - June 2017 - 651
Foot & Ankle International - June 2017 - 652
Foot & Ankle International - June 2017 - 653
Foot & Ankle International - June 2017 - 654
Foot & Ankle International - June 2017 - 655
Foot & Ankle International - June 2017 - 656
Foot & Ankle International - June 2017 - 657
Foot & Ankle International - June 2017 - 658
Foot & Ankle International - June 2017 - 659
Foot & Ankle International - June 2017 - 660
Foot & Ankle International - June 2017 - 661
Foot & Ankle International - June 2017 - 662
Foot & Ankle International - June 2017 - 663
Foot & Ankle International - June 2017 - 664
Foot & Ankle International - June 2017 - 665
Foot & Ankle International - June 2017 - 666
Foot & Ankle International - June 2017 - 667
Foot & Ankle International - June 2017 - 668
Foot & Ankle International - June 2017 - 669
Foot & Ankle International - June 2017 - 670
Foot & Ankle International - June 2017 - 671
Foot & Ankle International - June 2017 - 672
Foot & Ankle International - June 2017 - 673
Foot & Ankle International - June 2017 - 674
Foot & Ankle International - June 2017 - 675
Foot & Ankle International - June 2017 - 676
Foot & Ankle International - June 2017 - 677
Foot & Ankle International - June 2017 - 678
Foot & Ankle International - June 2017 - 679
Foot & Ankle International - June 2017 - 680
Foot & Ankle International - June 2017 - 681
Foot & Ankle International - June 2017 - 682
Foot & Ankle International - June 2017 - 683
Foot & Ankle International - June 2017 - 684
Foot & Ankle International - June 2017 - 685
Foot & Ankle International - June 2017 - 686
Foot & Ankle International - June 2017 - 687
Foot & Ankle International - June 2017 - 688
Foot & Ankle International - June 2017 - 689
Foot & Ankle International - June 2017 - 690
Foot & Ankle International - June 2017 - 691
Foot & Ankle International - June 2017 - 692
Foot & Ankle International - June 2017 - 693
Foot & Ankle International - June 2017 - 694
Foot & Ankle International - June 2017 - 695
Foot & Ankle International - June 2017 - 696
Foot & Ankle International - June 2017 - 697
Foot & Ankle International - June 2017 - 698
Foot & Ankle International - June 2017 - 699
Foot & Ankle International - June 2017 - 700
Foot & Ankle International - June 2017 - 701
Foot & Ankle International - June 2017 - 702
Foot & Ankle International - June 2017 - CT1
Foot & Ankle International - June 2017 - CT2
Foot & Ankle International - June 2017 - 4A
Foot & Ankle International - June 2017 - 4B
Foot & Ankle International - June 2017 - Cover3
Foot & Ankle International - June 2017 - Cover4
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2020
https://www.nxtbook.com/nxtbooks/sage/psychologicalscience_demo
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2020
https://www.nxtbook.com/nxtbooks/sage/fai_202009
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_august2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2019
https://www.nxtbook.com/nxtbooks/sage/fai_201909
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_july2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2019
https://www.nxtbook.com/nxtbooks/sage/canadianpharmacistsjournal_05062019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2019
https://www.nxtbook.com/nxtbooks/sage/sri_supplement_201903
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2018
https://www.nxtbook.com/nxtbooks/sage/tec_20180810
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2018
https://www.nxtbook.com/nxtbooks/sage/fai_201807
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2018
https://www.nxtbook.com/nxtbooks/sage/sri_supplement_201803
https://www.nxtbook.com/nxtbooks/sage/slas_discovery_201712
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_november2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_september2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2017
https://www.nxtbook.com/nxtbooks/sage/fai_supplement_201709
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_may2017
https://www.nxtbook.com/nxtbooks/sage/fai_201706
https://www.nxtbook.com/nxtbooks/sage/fai_201607
https://www.nxtbookmedia.com