A new technique for tibialis posterior tendon transfer

Purpose of the study The purpose of the study was to adjust a palliative transfer using the Tibialis Posterior (TP) tendon in case of foot dorsiflexion palsy. The surgical procedure emphasized some functional features, in an attempt to lessen parasitical motion of the foot in abduction or in adduction when patients bear the ankle joint in dorsiflexion, and to strenghten the transfer. Material and methods The surgical technique was carried out four times in patients, with a follow-up of six to eighteen months. One 20 cm long leg incision, on the antero-lateral part of tibia, up to the retinaculum of extensors tendons, allowed a section of Tibialis Anterior (TA) tendon as proximal as possible, and an aperture through the tibiofibular fascia in its lower third. One 15 cm long leg incision, along the postero-medial edge of the tibia, toward medial malleolus, allowed a release of the TP tendon after distal section. The tendon was rerouted across the former fascia aperture. One 6 cm foot medial incision face to navicuiar bone, where the TA tendon was thoroughly extracted and diverted, close to the sole side of the medial cuneiforme, and the two medial metatarsal bones. One 5 cm foot dorsal incision was performed, opposite to the 2d intermetatarsal space, where the diverted TA tendon end was recovered and pulled along a tunnel beneath the retinaculum of extensors. It was thus sutured, with a satisfactory tension to the TP tendon transfered across the tibiofibular fascia. Weight bearing in a short leg cast was allowed. Results, Discussion, Conclusion In the four cases, the results fulfilled the goal, with a satisfactory evaluation of the efficacy of the transfer, even the TA tendon was once intentionally diverted through the Ist metatarsal space instead of the second one, without any damage for the vessels pedicle. Among the widespread use of TP tendon, we think that a more neutral position of the tendon should be adopted with a curse coming along the extension of the leg axis, to the 2d intermetatarsal space. The more distally the transfer may be bound, the much efficient it will be. Obviously, there is no change in a correct automatic use of the transfer in gait. Even though it requires more experience and much longer follow-up time, this technique ensure a reliable and comfortable attachment of the transfered tendon, by a tendon-to-tendon suture, and secure a better restored foot dorsiflexion.