How is a tendon transfer performed in the treatment of foot drop?

Updated: Mar 23, 2020
  • Author: James W Pritchett, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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With a tendon transfer, retraining of the transferred tendon and stretching exercises for the Achilles tendon are advocated. Retraining may be avoided with a neurotendinous transposition of the gastrocnemius and the proximal end of the deep peroneal nerve.

This procedure requires very specific patient selection in the subgroup with persistent traumatic peroneal nerve palsy. The common peroneal nerve lesion must be at or distal to the branching from the tibial nerve (to guarantee that intact motor fibers proximal to the lesion are available for transposition). Paralysis must be permanent.

Specifically, there must be no recovery of function for at least 18 months after injury or after the most recent attempt at exploration or repair. Electrodiagnostic changes indicative of permanent damage must be present. Also, there must be good passive range of motion, with at least 90° of dorsiflexion. The muscles innervated by the tibial nerve must be normal. Finally, soft-tissue coverage must be adequate.

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