scholarly journals Long-Term Patient Reported Outcomes after Correction of Traumatic Foot Drop

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Jessica M. Kohring ◽  
Steven Karnyski ◽  
Peter Joo ◽  
Andrew Y. Liu ◽  
Judith F. Baumhauer ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Traumatic Injury ◽  
Common Peroneal Nerve ◽  
Subscale Score ◽  
Foot Drop ◽  
Assistive Device ◽  
Patient Reported

Category: Trauma; Ankle Introduction/Purpose: There is limited literature on patient reported outcomes after tendon transfer for traumatic foot drop. The purpose of this study was to determine long-term patient reported functional outcomes after posterior tibialis tendon (PTT) transfer in patients with foot drop resulting from a traumatic common peroneal nerve injury. Methods: Between August 2006 to January 2019, 31 patients underwent PTT transfer for foot drop secondary to a traumatic injury to their common peroneal nerve at our institution. The average follow-up was 14 months. A retrospective chart review was performed to document physical exam measures and to review postoperative radiographs for changes in foot alignment. There were 17 out of the initial 31 patients available at a mean follow-up of 5.9 years who responded to a phone questionnaire, including the Foot and Ankle Ability Measure (FAAM) questionnaire, and questions on brace and assistive device use, activity level, and satisfaction with surgery. Results: Preoperatively, all patients had an equinus contracture with no dorsiflexion strength, abnormal gait, and used an ankle- foot orthosis (AFO) or pneumatic boot for ambulation. Postoperatively, the average ankle dorsiflexion strength was 4/5 with 28/31 patients reporting a normal gait and 26/31 not using a brace for ambulation. Postoperative radiographs did not show changes in alignment or progression to flatfoot deformity. For the subset of 17 patients who responded to the phone questionnaire, the mean FAAM ADL subscale score was 68.1 and the Sport subscale score was 52.1 at an average of 5.9 years after surgery. The majority of patients (76%) were very or quite satisfied with the outcome of surgery and 15/17 (88%) patients reported they would undergo the PTT transfer procedure again. Conclusion: Posterior tibialis tendon transfer for patients with foot drop secondary to a traumatic injury to their common peroneal nerve showed a high satisfaction rate and improvement in function after surgery without the need for brace or assistive device use at long-term follow-up at an average of 6 years. Additionally, there was no progression to flatfoot deformity after posterior tibialis tendon transfer at 1 year postoperatively. [Table: see text]

Does Functional Electrical Stimulation for Foot Drop Strengthen Corticospinal Connections?

2009 ◽  
Vol 24 (2) ◽  
pp. 168-177 ◽  
Author(s):  
Dirk G. Everaert ◽  
Aiko K. Thompson ◽  
Su Ling Chong ◽  
Richard B. Stein
Keyword(s):  
Electrical Stimulation ◽  
Therapeutic Effect ◽  
Functional Electrical Stimulation ◽  
Peroneal Nerve ◽  
Walking Speed ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Walking Performance ◽  
The Common

Background. Long-term use of a foot-drop stimulator applying functional electrical stimulation (FES) to the common peroneal nerve improves walking performance even when the stimulator is off. This “therapeutic” effect might result from neuroplastic changes. Objective. To determine the effect of long-term use of a foot-drop stimulator on residual corticospinal connections in people with central nervous system disorders. Methods. Ten people with nonprogressive disorders (eg, stroke) and 26 with progressive disorders (eg, multiple sclerosis) used a foot-drop stimulator for 3 to 12 months while walking in the community. Walking performance and electrophysiological variables were measured before and after FES use. From the surface electromyogram of the tibialis anterior muscle, we measured the following: (1) motor-evoked potential (MEP) from transcranial magnetic stimulation over the motor cortex, (2) maximum voluntary contraction (MVC), and (3) maximum motor wave (Mmax) from stimulating the common peroneal nerve. Results. After using FES, MEP and MVC increased significantly by comparable amounts, 50% and 48%, respectively, in the nonprogressive group and 27% and 17% in the progressive group; the changes were positively correlated ( R2 = .35; P < .001). Walking speed increased with the stimulator off (therapeutic effect) by 24% ( P = .008) and 7% ( P = .014) in the nonprogressive and progressive groups, respectively. The changes in Mmax were small and not correlated with changes in MEP. Conclusions. The large increases in MVC and MEP suggest that regular use of a foot-drop stimulator strengthens activation of motor cortical areas and their residual descending connections, which may explain the therapeutic effect on walking speed.

Tibialis Posterior Tendon Transfer in Post Injection Common Peroneal Nerve Palsy in a Paediatric Patient–A Case Report

2015 ◽  
Vol 26 (1) ◽  
pp. 17-19
Author(s):  
Pebam Sudesh ◽  
Deepak Kumar
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Tibialis Posterior ◽  
Peroneal Nerve Palsy ◽  
Post Injection ◽  
Common Peroneal Nerve Palsy ◽  
Tibialis Posterior Tendon Transfer

Abstract Post injection foot drop is due to common peroneal nerve damage at site of injection (gluteal region) in which dorsiflexor of foot EHL, EDL and tibialis anterior are weakend or paralysed. It can be managed by reconstructive surgery; tibialis posterior tendon transfer to EHL, EDL and 2nd metatarsal. Here objective is rehabilitation of post injection common peroneal nerve palsy foot drop in a paeditaric patient. Our method and outcome measure as first rehabilitation programme for foot drop paediatric patient (common peroneal nerve palsy) thereafter reconstructive surgery of tibialis posterior transfer to EHL, EDL and 2nd metatarsal. Last we re-educate them to tibialis posterior contraction for dorsiflexion of foot. Our result was patient was able to walk similar as normal, able to elevate her toes and foot. Patient was happy and confident with her functional foot. But patient was advised to avoid heavy work, sprinting, and active aggressive game (like foot ball). Our conclusion is patient gets benefited by this procedure.

Functional Outcomes Following Anterior Transfer of the Tibialis Posterior Tendon for Foot Drop Secondary to Peroneal Nerve Palsy

2017 ◽  
Vol 38 (6) ◽  
pp. 627-633 ◽  
Author(s):  
Byung-Ki Cho ◽  
Kyoung-Jin Park ◽  
Seung-Myung Choi ◽  
Se-Hyuk Im ◽  
Nelson F. SooHoo
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Foot Drop ◽  
Tibialis Posterior ◽  
Control Group ◽  
Peroneal Nerve Palsy ◽  
Tibialis Posterior Tendon ◽  
Tibialis Posterior Tendon Transfer

Background: This retrospective comparative study reports the practical function in daily and sports activities after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Methods: Seventeen patients were followed for a minimum of 3 years after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Matched controls were used to evaluate the level of functional restoration. Functional evaluations included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) scores, and isokinetic muscle strength test. Radiographic evaluation for the changes of postoperative foot alignment included Meary angle, calcaneal pitch angle, hindfoot alignment angle, and navicular height. Results: Mean AOFAS, FAOS, and FAAM scores significantly improved from 65.1 to 86.2, 55.6 to 87.8, and 45.7 to 84.4 points at final follow-up, respectively. However, all functional evaluation scores were significantly lower as compared to the control group ( P < .001). Mean peak torque (60 degrees/sec) of ankle dorsiflexors, plantarflexors, invertors, and evertors at final follow-up were 7.1 (deficit ratio of 65.4%), 39.2, 9.8, and 7.3 Nm, respectively. These muscle strengths were significantly lower compared to the control group ( P < .001). No significant differences in radiographic measurements were found, and no patients presented with a postoperative flat foot deformity. One patient (5.9%) needed an ankle-foot orthosis for occupational activity. Conclusions: Anterior transfer of the tibialis posterior tendon appears to be an effective surgical option for paralytic foot drop secondary to peroneal nerve palsy. Although restoration of dorsiflexion strength postoperatively was about 33% of the normal ankle, function in daily activities and gait ability were satisfactorily improved. In addition, tibialis posterior tendon transfer demonstrated no definitive radiographic or clinical progression to postoperative flat foot deformity at intermediate-term follow-up. Level of Evidence: Level IV, retrospective case series.

Current Concepts Review: Common Peroneal Nerve Palsy After Knee Dislocations

2021 ◽  
pp. 107110072199542
Author(s):  
Christopher J. Dy ◽  
Paul M. Inclan ◽  
Matthew J. Matava ◽  
Susan E. Mackinnon ◽  
Jeffrey E. Johnson
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Knee Dislocation ◽  
Common Peroneal Nerve ◽  
High Rate ◽  
Foot Drop ◽  
Coordinated Care ◽  
Tibialis Muscle ◽  
Common Peroneal Nerve Palsy ◽  
Coordination And Collaboration

Dislocation of the native knee represents a challenging injury, further complicated by the high rate of concurrent injury to the common peroneal nerve (CPN). Initial management of this injury requires a thorough neurovascular examination, given the prevalence of popliteal artery injury and limb-threatening ischemia. Further management of a knee dislocation with associated CPN palsy requires coordinated care involving the sports surgeon for ligamentous knee reconstruction and the peripheral nerve surgeon for staged or concurrent peroneal nerve decompression and/or reconstruction. Finally, the foot and ankle surgeon is often required to manage a foot drop with a distal tendon transfer to restore foot dorsiflexion. For instance, the Bridle Procedure—a modification of the anterior transfer of the posterior tibialis muscle, under the extensor retinaculum, with tri-tendon anastomosis to the anterior tibial and peroneus longus tendons at the anterior ankle—can successfully return patients to brace-free ambulation and athletic function following CPN palsy. Cross-discipline coordination and collaboration is essential to ensure appropriate timing of operative interventions and ensure maintenance of passive dorsiflexion prior to tendon transfer.

scholarly journals Drop Foot Secondary to a Peroneal Intraneural Ganglion Connected to the Superior Tibiofibular Joint: A Case Report

2020 ◽  
Author(s):  
Kenan Kıbıcı ◽  
Berrin Erok ◽  
Akın Onat
Keyword(s):  
Peroneal Nerve ◽  
Imaging Modality ◽  
Axonal Neuropathy ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Intraneural Ganglion ◽  
Articular Branch ◽  
Ankle Eversion ◽  
Adjacent Structures ◽  
Tibiofibular Joint

AbstractPeroneal neuropathy is the most frequent mononeuropathy of the lower extremity. Intraneural ganglion cysts (INGCs) are among rare causes of peroneal nerve palsy. According to the articular (synovial) theory, the articular branch plays the key role in the pathogenesis. Patients present with pain around the fibular head and neck, motor weakness resulting in foot drop and paresthesia in the anterolateral calf and foot. Ultrasonography (US) and MRI are both useful in the diagnosis, but MRI is the best imaging modality in the demonstration of the articular connection and the relation of the cyst with adjacent structures, even without special neurography sequences. We present a 32-year-old male patient referred to our neurosurgery clinic with suspicion of lumbar radiculopathy. He presented with right foot drop which began 3 weeks prior. On examination, there was 90% loss in the ankle dorsiflexion and finger extension. Ankle eversion was also weakened. There was no low back or posterolateral thigh pain to suggest L5 radiculopathy and sciatic neuropathy. Following negative lumbar spine MRI, peripheral neuropathy was concerned. Electrodiagnostic evaluations findings were consistent with acute/subacute common peroneal nerve (CPN) axonal neuropathy. Subsequent MRI of knee showed a homogeneous, thin-walled tubular cystic lesion, extending along the course of the CPN and its articular branch. Full recovery of the neuropathy was achieved with early diagnosis and decompression via microsurgical epineurotomy. The diagnosis of INGC was confirmed by histopathologic examination. INGCs, although rare, should also be considered in the differential diagnosis of peripheral mononeuropathies.

scholarly journals Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

2021 ◽  
Author(s):  
Miguel Estuardo Rodríguez-Argueta ◽  
Carlos Suarez-Ahedo ◽  
César Alejandro Jiménez-Aroche ◽  
Irene Rodríguez-Santamaria ◽  
Francisco Javier Pérez-Jiménez ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Common Peroneal Nerve ◽  
Posterior Tibial Tendon ◽  
Drop Foot ◽  
Posterior Tibial ◽  
Anterior Tibial ◽  
Anterior Tibial Tendon ◽  
Peroneal Nerve Injury ◽  
Improve Reliability

312 Retrospective Analysis of Long-Term Scarring Outcomes in Paediatric Burns Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Mistry
Keyword(s):  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Burn Patients ◽  
Burn Scar ◽  
Common Presentation ◽  
Paediatric Burns ◽  
Significant Difference ◽  
Patient Reported

Abstract Introduction Paediatric burns are a common presentation to a plastic surgery unit. The long-term scar outcomes in paediatric burns patients are relatively unknown as most are discharged after 6 weeks follow up. We aimed to determine whether the long-term scarring outcomes are significantly different in those who had surgical treatment with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings, in a cohort of paediatric burns patients. Method The parents of all paediatric burns patients admitted to Stoke Mandeville Hospital from October 2014 to September 2017 were contacted by telephone to fill in the Brisbane Burn Scar Impact Profile (BBSIP), a patient reported outcome measure specifically aimed at children. The results from the questionnaires underwent statistical analysis to see if there was a significant difference in questionnaire scores between children treated surgically versus those treated conservatively. Results A total of 107 children were admitted in the timeframe, responses were received from 34 patients with 13 having been treated surgically and 21 having been treated conservatively. In all 58 questions that make up the BBSIP, there was no statistically significant difference observed in the scores of those treated surgically versus those treated conservatively. For 31 questions on the BBSIP, the lowest score indicating the best outcome was observed in all patients in both groups. Conclusions We found no statistically significant difference in the long-term scar outcomes as assessed by the BBSIP in paediatric burn patients treated with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings.

Ten-year follow-up of stemmed hemiarthroplasty for acute proximal humeral fractures

2021 ◽  
Vol 103-B (6) ◽  
pp. 1063-1069
Author(s):  
Alexander Amundsen ◽  
Stig Brorson ◽  
Bo S. Olsen ◽  
Jeppe V. Rasmussen
Keyword(s):  
Revision Rate ◽  
Patient Reported Outcome ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Patient Reported ◽  
Cumulative Revision Rate

Aims There is no consensus on the treatment of proximal humeral fractures. Hemiarthroplasty has been widely used in patients when non-surgical treatment is not possible. There is, despite extensive use, limited information about the long-term outcome. Our primary aim was to report ten-year patient-reported outcome after hemiarthroplasty for acute proximal humeral fractures. The secondary aims were to report the cumulative revision rate and risk factors for an inferior patient-reported outcome. Methods We obtained data on 1,371 hemiarthroplasties for acute proximal humeral fractures from the Danish Shoulder Arthroplasty Registry between 2006 and 2010. Of these, 549 patients (40%) were alive and available for follow-up. The Western Ontario Osteoarthritis of the Shoulder (WOOS) questionnaire was sent to all patients at nine to 14 years after primary surgery. Revision rates were calculated using the Kaplan-Meier method. Risk factors for an inferior WOOS score were analyzed using the linear regression model. Results Mean age at surgery was 67 years (24 to 90) and 445 (81%) patients were female. A complete questionnaire was returned by 364 (66%) patients at a mean follow-up of 10.6 years (8.8 to 13.8). Mean WOOS score was 64 (4.3 to 100.0). There was no correlation between WOOS scores and age, sex, arthroplasty brand, or year of surgery. The 14-year cumulative revision rate was 5.7% (confidence interval 4.1 to 7.2). Patients aged younger than 55 years and patients aged between 55 to 74 years had 5.6-times (2.0 to 9.3) and 4.3-times (1.9 to 16.7) higher risk of revision than patients aged older than 75 years, respectively. Conclusion This is the largest long-term follow-up study of acute proximal humeral fractures treated with hemiarthroplasty. We found a low revision rate and an acceptable ten-year patient-reported outcome. The patient-reported outcome should be interpreted with caution as we have no information about the patients who died or did not return a complete WOOS score. The long-term outcome and revision rate suggest that hemiarthroplasty offers a valid alternative when non-surgical treatment is not possible. Cite this article: Bone Joint J 2021;103-B(6):1063–1069.

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