(mentions CMT) Dorsal release of the ankle with transfer of the posterior tibial

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Oper Orthop Traumatol. 2009 Dec;21(6):533-44.

Dorsal release of the ankle with transfer of the posterior tibial tendon in

patients with paralytic drop foot

Fuhrmann RA, Wagner A.

Lehrstuhl für Orthopädie der Friedrich-Schiller-Universität Jena am

Rudolf-Elle-Krankenhaus, Eisenberg, Germany.

OBJECTIVE : Realignment of a fixed drop foot to restore gait pattern.

INDICATIONS : Drop foot due to various neurologic disorders (cerebral spastic

palsy, traumatic nerve palsy, Charcot-Marie-Tooth disease) with/without dynamic

equinovarus deformity and undisturbed function of the posterior tibial

muscle-tendon unit.

CONTRAINDICATIONS : Osseous deformities leading to drop foot, degenerative joint

disease of the ankle, flexion deformity of the midfoot, scar adhesions around

the muscle-tendon unit of the posterior tibial muscle, functional deficits of

the posterior tibial muscle, ulcers, or soft-tissue damage.

SURGICAL TECHNIQUE : Prone position: Z-shaped lengthening of the Achilles tendon

and open arthrolysis of the posterior ankle and subtalar joint. Supine position:

distal tenotomy of the posterior tibial tendon at the navicular. Exposure of the

tendon proximally to the medial malleolus. Transposition of the tendon slip

along the posterior tibial surface through the interosseous membrane to the

distal lower leg. Further rerouting of the tendon beneath the extensor

retinaculum to the midfoot. Reinsertion of the posterior tibial tendon to the

second or third cuneiform bone.

POSTOPERATIVE MANAGEMENT : Immobilization of the ankle in neutral position

within a plaster or a walker for 6 weeks, followed by a rigid orthosis and

physiotherapy.

RESULTS : Six patients (mean age 52 years) presented with a neurologic fixed

drop foot deformity that had developed more than 8.3 years ago. After 12 months,

five patients showed a neutral hindfoot position; one patient exhibited a

plantar flexion of 5 degrees . Active dorsiflexion was limited in four patients

(MRC [Medical Research Council] 2/5) and not visible in one patient. Total range

of motion comprised 20 degrees (active) and 35 degrees (passive). During

barefoot walking patients showed a regular swing phase of the concerned leg.

Patients estimated the overall result as good or excellent.