Tibialis posterior transfer in peripheral palsy of foot levators: apropos of 15 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
Aim: To evaluate efficiency of the tibialis posterior muscle transfer in patients with peripheral palsy of foot levators, and to determine occurrence of adverse effects on the static foot posture.
Patients and Methods :
Fifteen patients were evaluated retrospectively at a median 90 months follow-up (8-219). Eight patients had truncal paralysis (femoral fracture, knee sprain, total hip arthroplasty), 5 radicular (spinal trauma, disk hernia, lumbar surgery) and 2 neuropathic paralysis. The tibialis posterior was transferred on the tibialis anterior in 9 cases, on the second cuneiform twice, three times on the peroneus brevis and once on the navicular. None was associated to a Lambrinudi hind foot osteotomy. Collected data concerned (a) function : orthotics need, walking distance, and a satisfaction score (/4) (b) deficiencies : amplitude of active dorsiflexion, dorsiflexion strength and plantar footprint and (c) radiographic analysis : , Djian angle and hindfoot alignment.
Results : The eleven patients wearing orthotics were completely weaned from it. Following the procedure, only one patient had a limited walking distance (50-200m). The mean satisfaction score was 2/4 (-3/4). Maximum dorsiflexion meanly reached the neutral position (-20 to 15) ; the arc of movement averaged 11° (0-36) during analytic testing and 4,5° (0-10) when walking. Dorsiflexion strength averaged 2,75 (0-5). Eleven patients had a normal plantar footprint and 4 a cavus foot. Djian angle averaged 122 (111-130) and the hindfoot alignment angle was 5,3° valgus. The Djian angle was the only angle to be significantly different from the contralateral non operated foot (p=0,015), with a trend to cavus foot.
Tibialis posterior muscle is effective in foot-drop due to peripheral paralysis. A flat valgus foot does not appear to be a long-term complication of this procedure. On the contrary, we found a trend to cavus foot.
Keywords : tibialis posterior transfer, peripheral palsy