Abstract
We describe a new anchoring method for tarsal tendon transfers in myelomeningocele patients to protect the sole of the foot from pressure sores and skin necrosis and to loosen the tension of the transferred tendon.Tendon transfer procedures were performed in 51 feet (33 patients) with myelomeningocele. We transferred tibialis anterior tendons to the second or third cuneiform in 19 with equinovarus deformities, and transferred tibialis anterior tendons to the calcaneus through the interosseous membrane in 32 with talipes calcaneus. Clinical results were evaluated with the muscle power of transferred tendons using manual muscle testing 6 months after surgery. The muscle test result was classified as good, fair, and poor.After passing the tendon through the bony hole, a 2.0-mm Kirschner wire was inserted from the sole to the tibia through the ankle joint at neutral. (It extended from the sole through the posterior cortex of the tibia.) The remaining part of the wire was bent and formed into a loop shaped like the Greek letter "zeta" (zeta). The thread was then tied to the loop of the wire as tightly as possible. In this way, there was no contact with the sole during anchoring, thus avoiding ulcers. In addition, the transferred tendon could be kept stable because the patient's ankle was fixed by the Kirschner wire.No cases of wound infection or skin necrosis of the sole occurred. In 49 of the 51 cases, transferred tendons were firmly anchored to tarsal bones. Muscle strength was good for 83%, fair for 13%, and poor for 4%. Consequently, 45 feet could obtain plantigrade pattern during their walking with shoe inserts or occasional use of ankle-foot orthoses.Our anchoring method has the advantage of protecting the sole of the foot from pressure sores and skin necrosis, as well as maintaining tension on the transferred tendon until it settles down in an anchor hole.
Highlights
Muscle imbalance in the lower extremity induces dynamic deformities of the foot
Our anchoring method has the advantage of protecting the sole of the foot from pressure sores and skin necrosis, as well as maintaining tension on the transferred tendon until it settles down in an anchor hole
Foot ulcer formation from skin pressure exerted by the button represents one of the most serious problems for patients with sensory loss in the lower extremities [1, 2, 6]
Summary
Muscle imbalance in the lower extremity induces dynamic deformities of the foot. patients with myelomeningoceles associated with muscle imbalance often suffer from dynamic deformities of the feet. Peabody first described the posterior tendon transfer of the tibialis anterior [7], and this procedure was modified by Geogiadis [4] With both approaches, Cole’s pull-out button method is usually used to anchor the transferred tendon as it is drawn tightly into the bony hole. Cole’s pull-out button method is usually used to anchor the transferred tendon as it is drawn tightly into the bony hole This button often causes an ulcer of the foot due to the button exerting pressure against the skin [6]. Ulcers occur more frequently in myelomeningocele patients because of sensory loss They cause the button to sink, loosening the tension of the transferred tendon, which in turn will lead to poor surgical results. Ulcers themselves may cause serious problems, such as skin defects and superficial or deep infections
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