Posterior tibialis tendon transfer for steppage gait: Functional results and indications

Abstract Introduction Common peroneal nerve injury is the most frequent nerve deficit affecting the lower limbs. This leads to foot drop and a so-called steppage gait. Primary surgical nerve repair has an unfavorable outcome in some series. One alternative is posterior tibialis tendon transfer, a procedure designed to achieve active dorsiflexion. The aim of this paper is to report the results we have obtained with this surgery. Methods Between January 2008 and June 2016, a total of 38 patients underwent posterior tibialis tendon transfer, but only those 29 who had a minimum 12-months follow-up were included in analysis. A subcutaneous approach was used for the transfer, with tendon-to-tendon suturing employed, using the tibialis anterior, extensor hallucis longus, extensor digitorum longus and peroneal tendons as targets. The Stanmore Scale was used to rate outcomes. Results Final results were excellent in 15 patients (52%), good in seven (24%), fair in three (10%) and poor in four (14%). Conclusions This tendon transfer procedure has a high success rate, both in our series and in the literature. Considering the poor results observed in primary nerve repair in some patients, we believe that posterior tibialis tendon transfer should be considered for the treatment of foot drop in selected patients.