Clinical Results of Transferring a Motor Branch of the Tibial Nerve to the Deep Peroneal Nerve for Treatment of Foot Drop

Abstract

The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.

Clinical Outcomes of Nerve Transfers in Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis

“…All included studies were retrospective case series published between 2008 and 2015. 1,2,15,16 The mean modified NOS score for the included studies was 5.0/6.0. [20][21][22]…”

“…Consequently, there has been considerable variability in the reported outcomes with the use of nerve transfers in peroneal nerve palsy. 1,2,[13][14][15][16][17] The objective of this work was to perform a systematic review and meta-analysis of the primary literature to assess the effectiveness of nerve transfer surgery in restoring ankle dorsiflexion in patients with peroneal nerve palsy.…”

Partial tibial nerve transfer to tibialis anterior for traumatic peroneal nerve palsy

“…The limited clinical outcome literature to date has shown inconsistent outcomes after tibial nerve transfer for tibialis anterior reanimation in adult patients and are summarized in Table . When considering partial tibial nerve transfers to the deep peroneal nerve, excellent results were reported by Nath et al (), where good outcomes (≥M4 grading of ankle dorsiflexion) were achieved in 7 of 9 patients, but Flores et al () described frustratingly poor results with only 1 of 10 of patients achieving a good outcome. In regards to partial tibial nerve transfers to the motor branches of tibialis anterior, which is the procedure described in this study, Giuffre et al () also described poor results with only 1 of 11 patients achieving a good outcome.…”

“…In regards to partial tibial nerve transfers to the motor branches of tibialis anterior, which is the procedure described in this study, Giuffre et al () also described poor results with only 1 of 11 patients achieving a good outcome. No authors reported any significant functional donor nerve deficit (Flores, Martins, & Siqueira, ; Giuffre, Bishop, Spinner, Levy, & Shin, ; Nath, Lyons, & Paizi, ). A more recent study by Leclère et al () also utilizing the partial tibial nerve transfer to motor branches of tibialis anterior demonstrated ≥M4 ankle dorsiflexion in 3 of 6 cases.…”

“…Several anatomical studies of partial tibial nerve transfers for reanimation of tibialis anterior have already suggested its potential in lower limb nerve reconstructive surgery; Bodily et al () and Flores () examined the feasibility of neurotization of the deep peroneal nerve with partial tibial nerve donor fascicles, whereas more recent studies by Pirela‐Cruz, Hansen, Terreros, Rossum, and West () and White, Cooper, Bain, and Levis, () discussed partial tibial nerve transfers directly to the motor branches of tibialis anterior, which is the surgical technique being discussed in this paper. Despite these anatomical studies, there are few papers in the literature that describe clinical outcomes of partial tibial nerve transfer to either the deep peroneal nerve or the motor branches of tibialis anterior in adults (Flores, Martins, & Siqueira, ; Giuffre, Bishop, Spinner, Levy, & Shin, ; Leclère, Badur, Mathys, & Vögelin, ; Nath, Lyons, & Paizi, ). The purpose of this article is to (1) document a prospective single‐surgeon case series using partial tibial nerve transfers to the motor branches of tibialis anterior, (2) evaluate functional outcomes using the Medical Research Council (MRC) scale, and (3) assess for potential prognostic factors.…”