Program

CO43-003

Oral Communication

Tibialis posterior transfer in central palsy of foot levators : a propos of 17 cases.

Dr Nadine NACHEFa, Dr Etienne ALLARTb, Dr Michel-Yves GRAUWINa, Dr Marc ROUSSEAUXb, Prof André THEVENONc, Prof Christian FONTAINEa

a Service d'orthopédie B, Hôpital R. Salengro, CHU de Lille, b Service de rééducation neurologique, cérébrolésions, Hôpital P. Swynghedauw, CHU de Lille, c Service de Médecine physique et de réadaptation, Hôpital P. Swynghedauw, CHU de Lille

Tibialis posterior transfer in central palsy of foot levators : a propos of 17 cases.

Aim: To evaluate, in spastic patients with a lack of tibialis anterior spontaneous contraction, the efficiency of the tibialis posterior transfer and the occurrence of adverse effects on the static foot posture.

Patients and Methods:

Seventeen patients were evaluated retrospectively, on average 69 months after intervention (9-108). Mean age was 47 years (26-61). Seven patients presented stroke, 4 cranial trauma, 3 medullar trauma, 3 patients suffered respectively from cerebral palsy, cerebral tumor and cervical myelopathy. The tibialis posterior was transferred on the tibialis anterior in 9 cases, on the peroneus brevis in 5 cases, on the calcaneocuboid capsule once and on both tibialis anterior and calcaneocuboid capsule once. Three isolated talo-navicular arthrodesis and one triple arthrodesis were associated.

Results: We found the need of orthosis decreased (p=0,021), 9 patients no longer needed their orthosis. The walking distance was significantly increased (p=0,031) in 9 patients. The average satisfaction score was 2.71/4 (0-4).

On average, the maximum active dorsiflexion reached the neutral position (-20 to 20) with knee extended and 6° (-10-20) with knee flexed; the arc of movement averaged 9° (0-40) knee extended and 16,2° (0-40) knee flexed during analytic testing and 2,8° (0-10) when walking. Only half of the patients presented a tenodesis effect when walking. Dorsiflexion strength averaged 1,5 (0-5). Six patients had a normal plantar footprint, 8 a cavus foot and 2 a flatfoot, without any worsening compared to preoperative status. The Djian angle averaged 119,5° (105-138) and the hindfoot alignment angle was 7,7° valgus. There was no significant difference with the non-operated foot.

Discussion

The tibialis posterior transfer is effective in foot-drop in half of the patients, with a tenodesis effect that is not systematic in spastic patients. A flat valgus foot does not appear to be a long-term complication of this procedure.

Keywords : tibialis posterior transfer, spasticity