Functional Outcomes after Tibial to Peroneal Nerve Transfer in Foot Drop Patients
Matthew WT Curran, MD1; Joshua DeSerres, MD1; Michael J Morhart, MD, M.Sc1; Jaret L. Olson, MD1; K. Ming Chan, MD2; (1)Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, (2)Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
Purpose: Due to co-activation of antagonistic muscles during gait, functional outcomes following tibial nerve transfer to the tibialis anterior muscle in patients with foot drop have been poor. The purpose of this study was to examine the effects of gait training on functional performance of patients who demonstrated successful reinnervation.
Methods: Using a prospective study design, a consecutive series of patients who underwent tibial nerve transfer to the tibialis anterior muscle were recruited. A terminal motor branch either to the gastrocnemius or toe flexor muscles was used. Once reinnervation was confirmed, the patients either underwent rehab gait training with biofeedback without bracing or used ankle foot orthosis full time. After a minimum of 12 month follow up, differences in ankle dorsiflexion was measured using Stanmore Questionnaire, a functional assessment that includes MRC grades, and quantitative force measurements. Differences between the two groups were compared with non-parametric statistics.
Results: Of the 16 patients who underwent tibial nerve transfer, EMG studies revealed successful reinnervation in 8 [6 males; 36 (22-40) years (median (IQR)]. Five were due to trauma and 3 from oncologic resection. The 5 patients in the rehab training group demonstrated significantly better functional ability as measured by Stanmore [90/100 (65-95) vs 30 (26-41) (p=0.02)] compared to 3 in the control group. Patients in the rehab group were able to walk, run and climb stairs without any walking aid. There was no difference in Stanmore scores between different etiologies (p= 0.76) and donor nerve (p=0.40). Force data from patients with above antigravity strength was 25(17-32)% compared to the contralateral side.
Conclusions: Overall the outcomes are mixed. Only 50% of patients had meaningful reinnervation of the tibialis anterior muscle following transfer. In those patients with successful reinnervation, rehab training significantly improved outcomes.
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