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Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 7, pp 903–910 | Cite as

Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements

  • Hans-Ulrich SteinauEmail author
  • Alexandra Tofaute
  • Kathrin Huellmann
  • Ole Goertz
  • Marcus Lehnhardt
  • Jessica Kammler
  • Lars Steinstraesser
  • Adrien Daigeler
Orthopaedic Surgery

Abstract

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.

Keywords

Tendon transfer Stirrup-plasty Bridle procedure Drop foot Peroneal palsy 

Notes

Acknowledgments

We thank Petra Ostheide who was very helpful in performing the dynamometer measurements, the Department of Biometry and Epidemiology, Ruhr-University, Bochum, R. Klaaßen-Mielke for assistance with statistical analysis, and Amanda Daigeler for her formal English revision of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Hans-Ulrich Steinau
    • 1
    Email author
  • Alexandra Tofaute
    • 1
  • Kathrin Huellmann
    • 1
  • Ole Goertz
    • 1
  • Marcus Lehnhardt
    • 1
  • Jessica Kammler
    • 1
  • Lars Steinstraesser
    • 1
  • Adrien Daigeler
    • 1
    • 2
  1. 1.Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University Hospital BergmannsheilRuhr-University BochumBochumGermany
  2. 2.Department of Hand, Plastic and Reconstructive Surgery, Burn CenterBG-Unfallklinik LudwigshafenLudwigshafenGermany

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