Tendon transfer in neuro-muscular foot

Main etiology of Foot deformity in neuro-muscular disorder is muscular weakness & tone imbalance. Most of time this deformity is progressive so it is very important to have a permanent solution. Tendon transfer plays a very important role in balancing the muscle tone & power around the foot.

1. Introduction

2. Indication

3. Deformity where tendon transfer are required?

4. Role of tendon transfer

5. Fundamental rules

6. Method of fixation

7. Methods of tendon transfer

8. Route of transfer

9. Assessment & Planning

10. Charcot-Marie-Tooth disease

11. Bridle procedure Tib Post and Pero longus pass to tib ant and Tib post attached distally to middle cuneiform

12. Cerebral Palsy

13. Tibialis anterior half tendon transfer in fore foot varus in Cerebral Palsy Forefoot varus deformity

14. Tib Post half tendon transfer in hindfoot varus deformity in cerebral palsy Tibialis post half tendon pass to peroneus brevis

15. PPRP

16. PPRP Mx by Peroneus Longus transfer to middle cuneiform Modified johns procedure Gastrocnemius aponeurotic Release Dropping of first metatarsal head TA& TP weak, Overworking FHL Gastroc tightness

17. CTEV

18. Tibialis anterior half tendon transfer in CTEV Tibialis ant half tendon pass to lateral cuniform Forefoot supination deformity

19. Foot drop

20. Foot drop Tibialis Post pass to dorsum of foot through interroseus window

21. Our experience : tendon transfer in foot surgery Problem Procedure No. of Pt. CP with hind foot varus Tib P ost half tend transfer 4 CTEV with supinat . deformity Tib Ant split half transfer- 10 CP with Forefoot varus 5 Meningo-myelocoel Tib A nt split half transfer 3 Tib Ant transfer to middle cuneiform 4 Peroneus longus transfer to dorsum 2 PPRP Peroneus longus transfer to dorsum of foot- 4 Tib Ant transfer to middle cuneiform 4 Tib Post Trans to dorsum 5 Foot drop Tibialis posterior transfer to dorsum of foot 7 Calcaneus gait FDL / Peron brevis + Tibialis anterior transfer to calcaneus 2

22. Take home message Excellent procedure for balancing the foot deformity Each step should be followed carefully Protection of tendon minimum for 3 month Other modality should be tried before tendon transfer Correction of deformity prior to tendon transfer Mobile joint for success of this procedure

23. M ore info on www.samvednatrust.com & www.trishlaortho.com Thanks