Foot Drop Correction: By Active Dorsiflexion or Tenodesis Effect?

Abstract

In their excellent paper, Dreher et al. attempt to answer the question of whether their previously described total split posterior tibial tendon transfer (“T-SPOTT”) works as an active dorsiflexor of the ankle or merely maintains ankle dorsiflexion through a tenodesis effect. The authors report the results of their T-SPOTT procedure performed in conjunction with other soft-tissue or osseous procedures on fourteen limbs in fourteen patients with a cavovarus foot and foot drop related to Charcot-Marie-Tooth disease. They performed preoperative and postoperative three-dimensional gait analysis using their previously validated foot model with seventeen well-defined osseous markers on the foot and leg to measure tibiotalar motion (actually plantar flexion and dorsiflexion of a line between the calcaneus and the navicular relative to the tibia), foot-tibia motion (plantar flexion and dorsiflexion of a line between the calcaneus and distal aspect of the first metatarsal relative to the tibia), and the medial arch angle (angle between the first metatarsal and a line from the medial aspect of the calcaneus to the navicular). The authors found that, at mean of twenty-nine months postoperatively, mean passive ankle dorsiflexion increased by 13° to 15° while mean passive ankle …