Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques

Khan, Arshad Ahmed; Rodriguez-Collazo, Edgardo; Lo, Erwin; Raja, Asim A.Z.; Yu, Sujin; Khan, Hamid A

doi:10.1016/j.cpm.2020.09.004

Cited by 6 publications

(3 citation statements)

References 53 publications

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“…Foot drop represents a complex pathological condition, requiring a multidisciplinary approach for appropriate evaluation and treatment [15]. When considering surgical management for the treatment of foot drop, it is first and foremost imperative to establish the cause of the condition.…”

Section: Discussionmentioning

confidence: 99%

Acute Foot Drop Caused by Intraneural Ganglion Cyst of the Peroneal Nerve: Literature Review and Case Report

della Vecchia,

Baldi,

Passavanti

et al. 2023

JPM

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Background: Foot drop (FD) is characterized by an inability to lift the foot against gravity because of dorsiflexor muscle weakness. The aim of the present study is to report a clinical case of acute non-traumatic FD in patients with peroneal intraneural ganglion, after performing a scoping review on the methodological management of this disease. Methods: We performed a review of the literature and reported the case of a 49-year-old man with acute FD caused by an intraneural ganglion cyst of the peroneal nerve. Results: Out of a total of 201 articles, 3 were suitable for our review beyond our case report. The acute FD caused by peroneal intraneural ganglion can be managed by a careful clinical–instrumental differential diagnosis. A targeted surgery with subsequent rehabilitation produced a satisfactory motor recovery. Conclusions: Acute FD requires an appropriate diagnostic–therapeutic framework to identify and effectively treat the causes in order to promote complete recovery

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Section: Discussionmentioning

confidence: 99%

Acute Foot Drop Caused by Intraneural Ganglion Cyst of the Peroneal Nerve: Literature Review and Case Report

della Vecchia,

Baldi,

Passavanti

et al. 2023

JPM

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“…The success of the application of nerve transfers in the upper extremity has promoted the potential use of nerve transfers in the lower extremity as a treatment alternative to nerve grafting, orthoses, and tendon transfer surgery (Giuffre et al, 2012). Bodily et al demonstrated the feasibility of neurotization of the deep peroneal nerve with partial tibial nerve donor fascicles in 2004 (Bodily et al, 2004; Curran et al, 2021; Ferris & Maciburko, 2017; Flores et al, 2013; Giuffre et al, 2012; Head et al, 2019; Khan et al, 2021; Nath et al, 2008). Subsequently, partial tibial nerve transfer for peroneal nerve palsy has been reported.…”

Section: Discussionmentioning

confidence: 99%

Partial tibial nerve transfer for iatrogenic peroneal nerve palsy after endovenous laser ablation for varicose veins of the lower extremity: A case report

Uemura¹,

Miyashima²,

Konishi³

et al. 2023

Microsurgery

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Postprocedural peroneal nerve palsy after endovenous laser ablation (EVLA) for varicose veins is rare and is associated with poor functional recovery. There have been no reports using tibial nerve transfer for iatrogenic peroneal nerve palsy after EVLA. Herein, we present a case with peroneal nerve injury after EVLA, which was successfully treated by partial tibial nerve transfer for the first time. A 75‐year‐old female presented with a right foot drop immediately after EVLA of the lesser saphenous vein. The ankle and toe dorsiflexion had a muscle grade of M0 on the British Medical Research Council muscle scale, without voluntary motor unit action potentials (MUAP) in the tibialis anterior (TA) muscle on the needle electromyography. Three months after the injury, surgical nerve exploration revealed a damaged common peroneal nerve with discoloration and scarring at the fibular head. Intraoperative deep peroneal nerve stimulation confirmed the absence of compound muscle action potentials in the TA. The best functioning motor fascicles of the tibial nerve were transferred to the deep peroneal main trunk involving motor branches of the TA, extensor digitorum longus, and extensor hallucis longus (EHL) through the interosseous membrane. The postoperative course was uneventful, with no complications. After 3 months of surgery, nascent MUAP appeared in the TA. After 24 months, the patient regained the TA and EHL muscle function and ambulation without an ankle‐foot orthosis and tibial nerve deficits. Thus, our procedure may serve as an alternative to nerve grafting, tendon transfer, and orthoses for better management of the major neural complications associated with EVLA.

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“…the following reasons. Firstly, nerve transfer still requires nerve anastomosis, but at present, a considerable number of patients cannot achieve good recovery results after nerve anastomosis (32). Furthermore, central plasticity after CPN injury with gait change also hinders the process of nerve rehabilitation to a certain extent (33).…”

Section: Discussionmentioning

confidence: 99%

Transfer of Soleus Muscular Branch of Tibial Nerve to Deep Fibular Nerve to Repair Foot Drop After Common Peroneal Nerve Injury: A Retrospective Study

et al. 2022

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ObjectiveCommon peroneal nerve (CPN) injury that leads to foot drop is difficult to manage and treat. We present a new strategy for management of foot drop after CPN injury. The soleus muscular branch of the tibial nerve is directly transferred to the deep fibular nerve, providing partial restoration of motor function.MethodsWe retrospectively reviewed eight patients treated for CPN injury between 2017 and 2019. The soleus muscular branch of the tibial nerve was transferred to the deep fibular nerve to repair foot drop. Electrophysiology was conducted, and motor function was assessed. Motor function was evaluated by measuring leg muscle strength during ankle dorsiflexion using the British Medical Research Council (BMRC) grading system and electromyography (EMG).ResultsIn 10–15 months postoperatively, EMG revealed newly appearing electrical potentials in the tibialis anterior, extensor hallucis longus, and extensor toe longus muscle (N = 7). Two patients achieved BMRC grade of M4 for ankle dorsiflexion, 2 patients achieved M3, 1 patient achieved M2, and 2 patients achieved M1. Four patients showed good functional recovery after surgery and could walk and participate in activities without ankle-foot orthotics.ConclusionSurgical transfer of the soleus muscular branch of the tibial nerve to the deep fibular nerve after CPN injury provides variable improvements in ankle dorsiflexion strength. Despite variable strength gains, 50% of patients achieved BMRC M3 or greater motor recovery, which enabled them to walk without assistive devices.

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Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques

Cited by 6 publications

References 53 publications

Acute Foot Drop Caused by Intraneural Ganglion Cyst of the Peroneal Nerve: Literature Review and Case Report

Acute Foot Drop Caused by Intraneural Ganglion Cyst of the Peroneal Nerve: Literature Review and Case Report

Partial tibial nerve transfer for iatrogenic peroneal nerve palsy after endovenous laser ablation for varicose veins of the lower extremity: A case report

Transfer of Soleus Muscular Branch of Tibial Nerve to Deep Fibular Nerve to Repair Foot Drop After Common Peroneal Nerve Injury: A Retrospective Study

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