Outcomes of Posterior Tibial Tendon Transfer in Patients With Foot Drop: A Case Series of 11 Patients

Abstract

Objective: Peroneal nerve (PN) injury is a common neuropathy that affects the lower extremities. It results in loss of dorsiflexion at the tibiotalar joint and eversion at the subtalar joint, ultimately leading to foot drop. Various etiological factors contribute to this pathology. Treatment options include conservative management, steroid therapy, nerve decompression, repair, and reconstruction. However, due to the uncertain outcomes of primary nerve procedures, secondary interventions such as tendon transfers (TTs) generally provide more satisfactory results. This is particularly effective in patients with chronic foot drop persisting for more than 2 years.

Methods: In this study, posterior tibial TT was performed on 11 patients with foot drop, transferring the tendon to the dorsal aspect of the foot. Seven patients had involvement of the left lower extremity, while 4 had right-sided involvement. The etiology included traumatic PN injury in 6 patients and nerve injury due to discopathy in 1 patient. In one case, foot drop developed following a PN injury caused by a bomb explosion.

Results: To evaluate clinical outcomes, patients were asked about their subjective satisfaction with the treatment, followed by an assessment using the Stanmore Evaluation Score and the Carayon Evaluation Criteria. Balance parameters and tibialis anterior muscle strength were also evaluated by physiotherapists using stabilometric analysis and a digital dynamometer. The results were analyzed statistically.

Conclusions: As a conclusion, posterior tibial TT combined with structured physiotherapy assessment was found to be a successful approach in restoring active dorsiflexion, improving balance, and enhancing functional recovery in patients with chronic foot drop.

Keywords: Foot drop; Muscle strength; Peroneal nerve injuries; Postural balance; Tendon transfer; Tibialis posterior/transplantation.