Tibialis posterior transfer by interosseous route for the correction of foot drop in leprosy.

This article summarises a prospective study to evaluate the long-term results produced by interosseous transfer of the tibialis posterior tendon for the correction of foot drop due to leprosy neuritis. The study was carried out in 120 feet in 69 patients. All patients had closed elongation of the tendo Achillis (ETA) before transfer of the bifurcated tibialis posterior tendon through the interosseous route to the tendons of tibialis anterior and peroneous tertius or brevis over the dorsum of feet. At final follow-up of average 24 months, all the patients with ETA had a significantly greater range of active dorsiflexion of more than 10 degrees above 90 degrees, which was not merely from the tenodesing effect. The results, in terms of improvement in gait and prevention of trophic changes, remained satisfactory. An interosseous route is preferred with split attachment to the tibialis anterior and to the peroneus brevis or tertius tendons.

[A long-term follow-up result of posterior tibialis muscle transfer for foot-drop in leprosy patients].

OBJECTIVE: To determine the long-term results and possible complications of the posterior tibialis transfer in correction of the foot-drop in leprosy patients, and to compare the results by the circum-tibial and interosseous routes. METHODS: From January to October 2001, 37 cases (treated from October 1989 to October 1999) were followed up. Walking gait, active dorsiflexion and plantar flexion of the ankle joint, deformities of the feet, and patients' satisfaction were recorded. RESULTS: Of 37 patients, 22 were treated by circum-tibial transfer, 15 by interosseous transfer. All patients' Achilles tendons were lengthened. Excellent and good results were obtained in 30 cases (86%). The active dorsiflexion was better by interosseous route than by circum-tibial route. Out of 35 patients followed up for 2-11 years (4 years on average), 14 had talipes varus in 22 by circum-tibial transfer, 2 had talipes varus in 13 by interosseous transfer; there was significant difference between two routes (P < 0.05). The complications included drop-toe(5 cases), muscle atrophy (4 cases), tendon rupture (1 case) and tendon adhesion (1 case). CONCLUSION: Tibialis posterior transfer with elongation of tendo Achilles can obtain excellent results in treating foot-drop due to leprosy. Interosseous route is preferred and physiotherapy is emphasized pre- and postoperatively.

Flexor hallucis longus transfer for chronic Achilles tendonosis.

A technique similar to the one described by Hansen for reconstruction of chronic Achilles tendinosis using the flexor hallucis longus (FHL) tendon was used in 26 patients (29 tendons). Follow-up on all 26 patients (mean age 51.3 years) is provided with an average follow-up 35 months (range, 12 to 58 months). All patients were evaluated postoperatively to assess pain, function, and alignment of the ankle and hindfoot. The AOFAS Foot Ratios for the ankle and hindfoot (total of 100 points) was used. Time to maximum improvement was 8.2 months (range, three to 20 months). Ankle-Hindfoot Scale ratings improved from 41.7 (range, 23 to 63) preoperatively to 90.1 (range, 49 to 100) postoperatively. All but three patients evaluated their result as good or excellent in regards to improved function and pain. No patient had a significant functional deficit or deformity of the hallux after transfer of the FHL tendon.

Surgical reconstruction of leprotic foot drop.

We have operated 152 patients for correction of foot-drop due to leprosy from March 1992 to July 1999. The method used was circumtibial transfer of the tibial is posterior to the tendons of extensor hellucis longus and the extensor digitorum longus in the foot together with lengthening of the Achilles tendon. The results were satisfactory in 135 of these cases as judged by adequate restoration of heel--toe gait and of active dorsiflexion. The follow up period ranged from 6 months to 8 years. Inadequate post-operative physiotherapy was the reason for unsatisfactory results in seventeen cases.

Surgical reconstruction of leprotic foot-drop.

We have operated on 25 patients for correction of foot-drop due to leprosy from March 1992 to July 1994. The method used was circumtibial transfer of the tibialis posterior to the tendons of extensor hellucis longus and the extensor digitorum longus in the foot together with lengthening of the Achilles tendon. The results were satisfactory in 20 of these cases as judged by adequate restoration of heel-toe gait and of active dorsiflexion. The follow-up period ranged from 6 months to 2 years. Inadequate post-operative physiotherapy was the reason for unsatisfactory results in five cases.

Tibialis posterior transfer for the correction of foot drop in leprosy. Long-term outcome.

A comparison was made of the results produced by the circumtibial and interosseous routes of transfer of tibialis posterior for the correction of foot drop due to leprosy neuritis. The findings in 69 feet, of which 63 also had elongation of tendo Achillis, showed that the interosseous route gave a much lower incidence of recurrent inversion deformity of the foot. The results, in terms of improvement in gait and prevention of trophic changes, were satisfactory.

Hemangioma cevernoso do tendão de Aquiles em hanseniano

A case of cavernous hemangioma of Achiles' tendon in a leprosy patient is presented. It is the purpose of this report to register this unusual association.