Abstract
BackgroundStudies have yet to determine the optimal height at which the posterior tibial tendon (PTT) can be re-routed and the tendon length discrepancy at different height levels in terms of PTT transfer via the circumtibial route. This cadaveric study was conducted to determine the optimal height of PTT subcutaneous transfer and to compare tendon length discrepancies at different heights.Materials and methodsTwenty-five fresh normal cadaveric lower legs were used for measurements. PTT was exposed and then isolated. An incision along the calf was made to re-route PTT outside the fascia. The upper edge of the incision was classified as point “a.” The distal tip of the tendon was classified as point “b.” The midpoints of the intermediate cuneiform, the lateral cuneiform, and the cuboid were defined as points “c,” “d,” and “e,” respectively. The lengths of “ab,” “ac,” “ad,” and “ae” were measured and compared at different height levels above the distal tip of the medial malleolus. Angles α, β, and γ between the tendon outside the fascia connecting to different bones and the tendon inside the fascia were also measured as tendons were transferred at different bones and different height levels. Experimental data were collected and analyzed.ResultsAt a height of ≥5 cm, all of the PTTs could reach the midpoints of the three bones. The lengths of ac, ad, and ae were significantly less than the length of ab (p < 0.05). At a height of 10 cm, angles α, β, and γ were 177° ± 2.1°, 170° ± 3.1°, and 164° ± 3.7°, respectively. These angles were not significantly different from those at a height of 11 cm (p >0.05).ConclusionsPTT transfer via the subcutaneous route could achieve an adequate length to be transferred to the intermediate cuneiform, the lateral cuneiform, and the cuboid from a height of 5 cm above the distal tip of the medial malleolus. A height of 10 cm could be optimal for PTT transfer in the three bones via the subcutaneous route.
Highlights
posterior tibial tendon (PTT) transfer via the subcutaneous route could achieve an adequate length to be transferred to the intermediate cuneiform, the lateral cuneiform, and the cuboid from a height of 5 cm above the distal tip of the medial malleolus
A height of 10 cm could be optimal for PTT transfer in the three bones via the subcutaneous route
Among the 25 cadavers, the PTTs were pulled to the midpoints of the intermediate cuneiform, the lateral cuneiform, and the cuboid via the subcutaneous pathway in all specimens
Summary
The posterior tibial tendon (PTT) can be subjected to anterior transfer, a surgical procedure performed to repair foot drop caused by several conditions, such as irreversible lesions in the peroneal nerve or the dorsiflexor muscles of the foot and the ankle [1,2,3,4,5], supinated equinovarus foot deformity secondary to club deformity [6], Charcot-Marie-Tooth disease [7], leprosy [7,8], mononeuropathy, trauma to the common peroneal nerve [8,9,10], cerebrovascular accident [11], and Duchenne’s muscular dystrophy [12] This procedure was first described by Ober in 1933 to treat foot drop via a circumferential route [7]. This cadaveric study was conducted to determine the optimal height of PTT subcutaneous transfer and to compare tendon length discrepancies at different heights
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