Surgical Treatment of Complete Foot Drop: Partial Tibial Nerve Transfer to the Motor Branch of the Tibialis Anterior: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Themistocles S Protopsaltis ◽  
Yesha H Parekh
Keyword(s):  
Surgical Treatment ◽  
Tibialis Anterior ◽  
Tibial Nerve ◽  
Donor Site ◽  
Tibialis Anterior Muscle ◽  
Nerve Transfer ◽  
Ankle Dorsiflexion ◽  
Foot Drop ◽  
Great Toe ◽  
Motor Branch

Abstract This video will be demonstrating the surgical treatment of complete foot drop with partial tibial nerve transfer to the motor branch of the tibialis anterior. Foot drop occurs when there is injury to the deep peroneal nerve that results in the paralysis of the tibialis anterior muscle and subsequent loss of ankle dorsiflexion.1-5 The patient who is the subject of this video is a 27-yr-old female with a 6-mo history of foot drop. She presented with complete loss of ankle dorsiflexion and great toe extension due to traumatic fall on her left knee while running. Upon physical examination, she had all the features of complete foot drop with loss of ankle dorsiflexion and ankle eversion. She also had decreased sensation to light touch over left dorsal foot, left great toe, and left lateral lower leg. The patient has consented to this procedure. The partial tibial nerve transfer to the motor branch of tibialis anterior muscle is the preferred treatment option for foot drop as it restores ankle dorsiflexion with minimal donor site complications. At 12 mo postsurgery, she has regained 4/5 for ankle dorsiflexion on motor testing compared to the 0/5 she had preoperatively.

scholarly journals Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

2011 ◽  
Vol 470 (3) ◽  
pp. 779-790 ◽  
Author(s):  
Jennifer L. Giuffre ◽  
Allen T. Bishop ◽  
Robert J. Spinner ◽  
Bruce A. Levy ◽  
Alexander Y. Shin
Keyword(s):  
Nerve Injury ◽  
Tibialis Anterior ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Nerve Transfer ◽  
Motor Branch ◽  
Peroneal Nerve Injury ◽  
Knee Trauma

Partial tibial nerve transfer for foot drop from deep peroneal palsy: Lessons from three pediatric cases

Microsurgery ◽  
2020 ◽  
Author(s):  
Christopher S. Crowe ◽  
Vincent S. Mosca ◽  
Marisa B. Osorio ◽  
Sarah P. Lewis ◽  
Raymond W. Tse
Keyword(s):  
Tibial Nerve ◽  
Nerve Transfer ◽  
Foot Drop ◽  
Peroneal Palsy

Anterior Interosseous–to–Ulnar Motor Nerve Transfers: A Single Center’s Experience in Restoring Intrinsic Hand Function

Hand ◽  
2020 ◽  
pp. 155894472092848
Author(s):  
Graham J. McLeod ◽  
Blair R. Peters ◽  
Tanis Quaife ◽  
Tod A. Clark ◽  
Jennifer L. Giuffre
Keyword(s):  
Outcome Measures ◽  
Motor Nerve ◽  
Hand Function ◽  
Donor Site ◽  
Nerve Transfer ◽  
Secondary Outcome ◽  
No Donor ◽  
Motor Branch ◽  
Nerve Transfers

Background: Transfer of the anterior interosseous nerve (AIN) into the ulnar motor branch improves intrinsic hand function in patients with high ulnar nerve injuries. We report our outcomes of this nerve transfer and hypothesize that any improvement in intrinsic hand function is beneficial to patients. Methods: A retrospective review of all AIN-to-ulnar motor nerve transfers, including both supercharged end-to-side (SETS) and end-to-end (ETE) transfers, from 2011 to 2018 performed by 2 surgeons was conducted. All adult patients who underwent this nerve transfer for any reason with greater than 6 months’ follow-up and completed charts were included. Primary outcome measures were motor function using the British Medical Research Council (BMRC) grading system and subjective satisfaction with surgery using a visual analog scale. Secondary outcome measures included complications and donor site deficits. Results: Of the 57 patients who underwent nerve transfer, 32 patients met the inclusion criteria. The average follow-up and average time to surgery were 12 and 15.6 months, respectively. The overall average BMRC score was 2.9/5, with a trend toward better recovery in patients who received earlier surgery (<12 months = BMRC 3.7, ≥12 months = BMRC 2.2; P < .01). Patients with an SETS transfer had better results that those with an ETE transfer (SETS = 3.2, ETE = 2.6). There were no donor deficits after operation. One patient developed complex regional pain syndrome. Conclusions: Patients with earlier surgery and an in-continuity nerve (receiving an SETS transfer) showed improved recovery with a higher BMRC grade compared with those who underwent later surgery. Any improvements in intrinsic hand function would be beneficial to patients.

Interosseous Nerve Transfers for Tibialis Anterior Muscle Paralysis (Foot Drop): A Human Cadaver-Based Feasibility Study

2008 ◽  
Vol 25 (03) ◽  
pp. 203-211 ◽  
Author(s):  
Miguel Pirela-Cruz ◽  
Uel Hansen ◽  
Daniel Terreros ◽  
Alfred Rossum ◽  
Priscilla West
Keyword(s):  
Feasibility Study ◽  
Tibialis Anterior ◽  
Tibialis Anterior Muscle ◽  
Foot Drop ◽  
Human Cadaver ◽  
Muscle Paralysis ◽  
Nerve Transfers

scholarly journals Clinical Results of Transferring a Motor Branch of the Tibial Nerve to the Deep Peroneal Nerve for Treatment of Foot Drop

Neurosurgery ◽  
2013 ◽  
Vol 73 (4) ◽  
pp. 609-616 ◽  
Author(s):  
Leandro Pretto Flores ◽  
Roberto Sérgio Martins ◽  
Mario Gilberto Siqueira
Keyword(s):  
Medical Research ◽  
Soleus Muscle ◽  
Peroneal Nerve ◽  
Research Council ◽  
Medical Research Council ◽  
Tibial Nerve ◽  
Foot Drop ◽  
Deep Peroneal Nerve ◽  
Motor Branch ◽  
Patient Reported

Abstract BACKGROUND: Foot drop is a very debilitating condition affecting patients' daily activities, and its treatment has been a challenge for neurosurgeons. Grafting the peroneal or sciatic nerve usually results in poor outcomes. Our previous anatomic study demonstrated the feasibility of transferring a motor branch of the tibial nerve to the deep peroneal nerve at the level of the popliteal fossa. OBJECTIVE: To demonstrate the outcomes obtained after the transfer of a branch of the tibial nerve to the peroneal nerve for recovery of foot drop. METHODS: A retrospective review of 13 patients with foot drop caused by injuries to a lumbar root or the sciatic or peroneal nerve, who underwent a transfer of the nerve of the soleus muscle to the deep peroneal nerve. The results were evaluated using the British Medical Research Council grading system. RESULTS: Three patients were lost to follow-up. Of the remaining 10 patients, the outcomes were considered good (Medical Research Council grade M3 or M4) in 2 patients (20%) concerning ankle dorsiflexion and in 2 patients concerning toe extension (20%). One patient reported a reduced calf circumference. CONCLUSION: The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.

scholarly journals Poststroke Muscle Architectural Parameters of the Tibialis Anterior and the Potential Implications for Rehabilitation of Foot Drop

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
John W. Ramsay ◽  
Molly A. Wessel ◽  
Thomas S. Buchanan ◽  
Jill S. Higginson
Keyword(s):  
Tibialis Anterior ◽  
Muscle Activation ◽  
Imaging Techniques ◽  
Tibialis Anterior Muscle ◽  
Functional Mobility ◽  
Foot Drop ◽  
Neutral Position ◽  
Plantar Flexors ◽  
Fascicle Length ◽  
Bilateral Differences

Poststroke dorsiflexor weakness and paretic limb foot drop increase the risk of stumbling and falling and decrease overall functional mobility. It is of interest whether dorsiflexor muscle weakness is primarily neurological in origin or whether morphological differences also contribute to the impairment. Ten poststroke hemiparetic individuals were imaged bilaterally using noninvasive medical imaging techniques. Magnetic resonance imaging was used to identify changes in tibialis anterior muscle volume and muscle belly length. Ultrasonography was used to measure fascicle length and pennation angle in a neutral position. We found no clinically meaningful bilateral differences in any architectural parameter across all subjects, which indicates that these subjects have the muscular capacity to dorsiflex their foot. Therefore, poststroke dorsiflexor weakness is primarily neural in origin and likely due to muscle activation failure or increased spasticity of the plantar flexors. The current finding suggests that electrical stimulation methods or additional neuromuscular retraining may be more beneficial than targeting muscle strength (i.e., increasing muscle mass).

Extensor Tendon Transfers for Treatment of Foot Drop in Charcot-Marie-Tooth Disease: A Biomechanical Evaluation

2020 ◽  
Vol 41 (4) ◽  
pp. 449-456
Author(s):  
Glenn B. Pfeffer ◽  
Max Michalski ◽  
Trevor Nelson ◽  
Tonya W. An ◽  
Melodie Metzger
Keyword(s):  
Tibialis Anterior Muscle ◽  
Extensor Tendon ◽  
Biomechanical Study ◽  
Ankle Dorsiflexion ◽  
Foot Drop ◽  
Optical Data ◽  
Primary Role ◽  
Tendon Transfers ◽  
Charcot Marie Tooth ◽  
Intact State

Background: In Charcot-Marie-Tooth (CMT) disease, selective weakness of the tibialis anterior muscle often leads to recruitment of the long toe extensors as secondary dorsiflexors, with subsequent clawing of the toes. Extensor hallucis longus (EHL) and extensor digitorum longus (EDL) tendon transfers offer the ability to augment ankle dorsiflexion and minimize claw toe deformity. The preferred site for tendon transfer remains unknown. Our goal was to quantify ankle dorsiflexion in the “intact” native tendon state, compared with tendon transfers to the metatarsal necks or the cuneiforms. We hypothesized that EHL and EDL transfers would improve ankle dorsiflexion as compared with the intact state and would produce similar motion when anchored at the metatarsal necks or cuneiforms. Methods: Eight fresh-frozen cadaveric specimens transected at the midtibia were mounted into a specialized jig with the ankle held in 20 degrees of plantarflexion. The EHL and EDL tendons were isolated and connected to linear actuators with suture. Diodes secured on the first metatarsal, fifth metatarsal, and tibia provided optical data for tibiopedal position in 3 dimensions. After preloading, the tendons were tested at 25%, 50%, 75%, and 100% of maximal physiologic force for the EHL and EDL muscles, individually and combined. Results: Transfers to metatarsal and cuneiform locations significantly improved ankle dorsiflexion compared with the intact state. No difference was observed between these transfer sites. Following transfer, only 25% of maximal force by combined EHL and EDL was required to achieve a neutral foot position. Conclusion: Transfer of the long toe extensors, into either the metatarsals or cuneiforms, significantly increased dorsiflexion of the ankle. Clinical Relevance: The transferred extensors can serve a primary role in treating foot drop in CMT disease, irrespective of the presence of clawed toes. This biomechanical study supports tendon transfers into the cuneiforms, which involves less time, fewer steps, and easier tendon balancing without compromising dorsiflexion power.

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