Tendon Transfer for Foot Drop
Tendon transfer surgery is a procedure used to aid and restore function when certain muscles stop working. Foot drop specifically, means a patient loses the ability to pull the foot up during walking, which can occur in certain neurological conditions, after hip replacement surgery, or when prolapsed discs press on the nerves that exit the spine.
Why have the surgery?
Nerve injuries can lead to certain muscle groups not working, such as those that help lift the foot up. Assuming the ankle is supple, and there is an expendable and appropriately powered muscle, an operation known as a tendon-transfer can be used to replicate some of the original ability of moving the foot up. This helps ground clearance during walking and stops patients tripping over themselves.
How is surgery performed?
The operation is typically performed under a general anaesthetic. In most cases, the tibialis posterior tendon is harvested which involves making incisions on the arch of the foot, and inner aspect of the leg below the level of the calf. Further incisions are made on the shin and top of the foot to allow the tendon to be re-routed to a position that will keep the foot up.
What are the benefits?
The surgery should help keep the foot up on its own and aid walking.
What are the risks?
All operations have risks, but the commonest and most concerning for this surgery are: - Recurrence, meaning that the problem comes back. - Nerve damage, since the incisions run in close proximity to a various nerves. Damage to these nerves can result in pain, number or a pain syndrome known as CRPS. - Blood clots, which can form in the leg and travel up to the lung where they can be fatal. This list is not exhaustive and Mr Patel can talk you through them all in more detail during a consultation.
What recovery is involved?
A plaster cast is used for six weeks to allow the tissues to heal after surgery. After six weeks, physiotherapy is started to re-train the foot to lift itself up, and during this rehabilitation, a splint is sometimes used to stop the foot from pointing downwards which can stretch the transferred tendon and defunction it.
Any other considerations?
Not all patients with a foot drop need surgery, since many can be managed with a splint. If the ankle joint has arthritis, then a tendon transfer in isolation is not typically appropriate, and a fusion of the ankle may be considered instead.