Posterior Tibial Transfer to the Lateral Cuneiform in a Young, Active Patient with Foot Drop: A Case Report

Abstract

Category:Ankle; Midfoot/Forefoot; Sports; OtherIntroduction/Purpose:We report the case of a 23-year-old male who underwent a posterior tibial tendon (PTT) transfer after suffering foot drop secondary to a traumatic knee dislocation five years earlier. The common peroneal nerve is a commonly injured peripheral nerve due to its anatomic location. Peroneal nerve palsy leads to the inability to clear the foot during the swing phase of gait due to paralysis of the tibialis anterior- the strongest dorsiflexor of the foot. In the event that nerve function does not spontaneously return, tendon transfer surgeries are an established definitive treatment. Despite this, the optimal method of tendon transfer has not yet been determined. Thus, pre-operative assessment and planning remains crucial in determining which method is to be used.Conclusion:Surgeons must decide which tendon to transfer, which route to utilize, and where to insert in effort to maximize biomechanical outcomes. Careful consideration must be made to ensure maximum strength and optimal forefoot balance to allow patients undergoing tendon transfer to become brace free. Our patient underwent a PTT transfer via the interosseous route to the lateral cuneiform- a common option for those with traumatic peroneal nerve injury. By three months post-operation, our patient achieved adequate dorsiflexion to clear swing phase. By one year post-operation and beyond, our patient has participated in physical activity brace free without any complications.