SLR - November 2021 - Kelsi M. Nutter

Tendon Transfer in Foot Drop: A Systematic Review

Reference: Stevoska, S., Pisecky, L., Stadler, C. et al. Tendon Transfer in Foot Drop: A Systematic Review. Arch Orthop Trauma Surg (2021). https://doi.org/10.1007/s00402-021-04162-x

Level of Evidence: Level 3

Scientific Literature Review

Reviewed By: Kelsi M. Nutter, DPM
Residency Program: Scripps Mercy Hospital – San Diego, CA

Podiatric Relevance: Foot drop is a rare but debilitating condition that can lead to recurrent falls and disability. The leading cause of foot drop is common fibular compression and treatment can present multiple challenges to the foot and ankle surgeon. Tendon transfers are the most common treatment choice for foot drop.

Methods: A systematic review of 37 studies assessing tendon transfer treatment options, as well as functional outcomes, for foot drop.

Results: Transferring the tibialis posterior tendon through the interosseous membrane was used in 79 percent of the cohorts. Transfer of the tibialis posterior tendon through the circumtibial route was performed in 2 percent of the cohorts. One used a peroneus longus transfer. Sixty seven percent used tendon-to-tendon fixation, 33 percent used tendon to bone fixation and 7 percent used a combination of the above. An Achilles tendon lengthening was performed in 60 percent.

Twenty-two studies discussed AFO use and 93 percent used AFO preoperatively. Ninety-one percent who used an AFO preoperatively did not use it post operatively.

Thirteen studies reported patient satisfaction and 94% of patients were satisfied with the outcome of their operation. Patient satisfaction, regardless of the transfer or the fixation technique used, showed similar results postoperatively.

Twenty-nine studies discussed post operatively ankle joint range of motion, all of which has significant improvement in ankle joint ROM post operatively.

Conclusions: Tendon transfer, namely posterior tibial tendon transfer, is the mainstay of treatment for foot drop. While this review was not a high-powered study, with the majority of studies being retrospective in nature and with small sample sizes, it showed favorable outcomes for tendon transfers for the treatment of foot drop. There have been multiple techniques described, including interosseous and circumtibial. This systematic review showed similarly favorable results in both groups postoperatively. Furthermore, functional outcomes showed favorable results, with the majority of patients no longer requiring AFO device postoperatively. Almost all studies showed an increased in dorsiflexion range of motion postoperatively. Ultimately, this study showed that posterior tibial tendon transfers, regardless of method, are effective in successfully treating foot drop, both subjectively and objectively. 

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