Tibialis posterior transfer in central palsy of foot levators: A propos of 17 cases

Tibialis posterior transfer in central palsy of foot levators: a propos of 17cases.AimTo evaluate, in spastic patients with a lack of tibialis anterior spontaneous contraction, the efficiency of the tibialis posterior transfer and the occurrence of adverse effects on the static foot posture.Patients and methodsSeventeen patients were evaluated retrospectively, on average 69months after intervention (9–108). Mean age was 47years (26–61). Seven patients presented stroke, 4cranial trauma, 3medullar trauma, 3patients suffered respectively from cerebral palsy, cerebral tumor and cervical myelopathy. The tibialis posterior was transferred on the tibialis anterior in 9cases, on the peroneus brevis in 5cases, on the calcaneocuboid capsule once and on both tibialis anterior and calcaneocuboid capsule once. Three isolated talo-navicular arthrodesis and one triple arthrodesis were associated.ResultsWe found the need of orthosis decreased (P=0,021), 9patients no longer needed their orthosis. The walking distance was significantly increased (P=0,031) in 9patients. The average satisfaction score was 2.71/4 (0–4).On average, the maximum active dorsiflexion reached the neutral position (−20 to 20) with knee extended and 6° (−10–20) with knee flexed; the arc of movement averaged 9° (0–40) knee extended and 16,2° (0–40) knee flexed during analytic testing and 2,8° (0–10) when walking. Only half of the patients presented a tenodesis effect when walking. Dorsiflexion strength averaged 1,5 (0–5). Six patients had a normal plantar footprint, 8 a cavus foot and 2 a flatfoot, without any worsening compared to preoperative status. The Djian angle averaged 119,5° (105–138) and the hindfoot alignment angle was 7,7° valgus. There was no significant difference with the non-operated foot.DiscussionThe tibialis posterior transfer is effective in foot-drop in half of the patients, with a tenodesis effect that is not systematic in spastic patients. A flat valgus foot does not appear to be a long-term complication of this procedure