Tibialis posterior transfer for foot drop due to central causes: Long-term hindfoot alignment.
Adult
Brain Neoplasms
/ complications
Calcaneus
/ diagnostic imaging
Cerebral Palsy
/ complications
Craniocerebral Trauma
/ complications
Female
Flatfoot
/ diagnostic imaging
Follow-Up Studies
Foot
/ diagnostic imaging
Gait
Humans
Male
Metatarsal Bones
/ diagnostic imaging
Middle Aged
Peroneal Neuropathies
/ etiology
Radiography
Retrospective Studies
Spinal Cord Injuries
/ complications
Stroke
/ complications
Talipes Cavus
/ diagnostic imaging
Talus
/ diagnostic imaging
Tendon Transfer
Time Factors
Tumor Protein, Translationally-Controlled 1
Brain injury
Equinus
Flatfoot
Foot drop
Stroke
Tendon transfer
Journal
Orthopaedics & traumatology, surgery & research : OTSR
ISSN: 1877-0568
Titre abrégé: Orthop Traumatol Surg Res
Pays: France
ID NLM: 101494830
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
12
12
2016
revised:
05
11
2018
accepted:
13
11
2018
pubmed:
29
12
2018
medline:
3
1
2020
entrez:
29
12
2018
Statut:
ppublish
Résumé
Tibialis posterior transfer (TPT) is the treatment most widely used to palliate foot drop due to dorsiflexor palsy. TPT has been extensively studied in patients with peripheral neurological causes of foot drop. In contrast, data are scarce on central foot drop, in which TPT is often blamed for causing flattening of the arches. The primary objective of this study was to assess the impact on foot alignment of TPT in patients with central foot drop. The secondary objective was to determine whether TPT combined with other surgical procedures improved gait. TTP can induce flattening of the medial arch of the foot. We retrospectively identified 13 patients managed with TPT (1 foot per patient). Mean follow-up was 65 months (range, 12-108 months). The causes were stroke (n=5), head injury (n=3), spinal cord injury (n=2), cervical spondylotic myelopathy (n=1), cerebral palsy (n=1), and a brain tumour (n=1). The clinical assessment focused chiefly on forefoot alignment and footprint parameters. The following variables were collected from weight-bearing radiographs: Djian-Annonier angle, Méary-Toméno angle, lateral arch angle, and calcaneal pitch angle in the sagittal plane; talo-metatarsal angle in the transverse plane; and rearfoot valgus angle in the coronal plane. Of the 13 feet, 6 had normal footprint parameters and 7 pes cavus. There were no cases of flatfoot. Pronation deformities and supination deformities were each found in 2 patients. Comparing the radiographic parameters between the two feet in each patient identified differences only for the lateral arch angle and calcaneal pitch angle, which indicated pes cavus on the operated side (operated side: 142.7° [range, 136°-156°], p=0.041; and 24° [range, 14°-33°], p=0.028, respectively). In contrast to the working hypothesis, we found no evidence of progression to valgus flatfoot after TPT transfer performed to treat central foot drop. IV, retrospective study with no control group.
Sections du résumé
BACKGROUND
Tibialis posterior transfer (TPT) is the treatment most widely used to palliate foot drop due to dorsiflexor palsy. TPT has been extensively studied in patients with peripheral neurological causes of foot drop. In contrast, data are scarce on central foot drop, in which TPT is often blamed for causing flattening of the arches. The primary objective of this study was to assess the impact on foot alignment of TPT in patients with central foot drop. The secondary objective was to determine whether TPT combined with other surgical procedures improved gait.
HYPOTHESIS
TTP can induce flattening of the medial arch of the foot.
PATIENTS AND METHODS
We retrospectively identified 13 patients managed with TPT (1 foot per patient). Mean follow-up was 65 months (range, 12-108 months). The causes were stroke (n=5), head injury (n=3), spinal cord injury (n=2), cervical spondylotic myelopathy (n=1), cerebral palsy (n=1), and a brain tumour (n=1). The clinical assessment focused chiefly on forefoot alignment and footprint parameters. The following variables were collected from weight-bearing radiographs: Djian-Annonier angle, Méary-Toméno angle, lateral arch angle, and calcaneal pitch angle in the sagittal plane; talo-metatarsal angle in the transverse plane; and rearfoot valgus angle in the coronal plane.
RESULTS
Of the 13 feet, 6 had normal footprint parameters and 7 pes cavus. There were no cases of flatfoot. Pronation deformities and supination deformities were each found in 2 patients. Comparing the radiographic parameters between the two feet in each patient identified differences only for the lateral arch angle and calcaneal pitch angle, which indicated pes cavus on the operated side (operated side: 142.7° [range, 136°-156°], p=0.041; and 24° [range, 14°-33°], p=0.028, respectively).
DISCUSSION
In contrast to the working hypothesis, we found no evidence of progression to valgus flatfoot after TPT transfer performed to treat central foot drop.
LEVEL OF EVIDENCE
IV, retrospective study with no control group.
Identifiants
pubmed: 30591416
pii: S1877-0568(18)30370-0
doi: 10.1016/j.otsr.2018.11.013
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
153-158Informations de copyright
Copyright © 2018. Published by Elsevier Masson SAS.