Surgical Outcome of Tibialis Posterior Tendon Transfer for Foot Drop in Leprosy Patients

Abstract

Leprosy is the most common treatable cause of neuropathy in the world. [1] The social stigma in leprosy is mainly due to nerve function impairment and subsequent disability. Loss of common peroneal nerve function leading to paralysis of the anterior and lateral compartment muscle groups in the leg is common in leprosy. Surgical correction of foot drop in leprosy is done by anterior transposition of the tibialis posterior tendon. The aim of the study is to assess the functional outcome of tibialis posterior tendon transfer procedure and to identify factors that impact favourable outcome of tibialis posterior tendon transfer. METHODSOur study is a prospective study of 50 leprosy patients who underwent tibialis posterior tendon transfer between Jan 2012 to Dec 2015 in Tagore Medical College Hospital. In our study of 50 patients, 44 were males and 6 were females with sex ratio 22:3. The maximum number of cases who underwent surgery were between 26 to 35 age group; 45 cases were borderline tuberculoid type (90%) and 5 cases were borderline lepromatous type (10%); 44 cases underwent interosseous route tendon transfer and 6 cases by circumtibial route tendon transfer. RESULTSBy modified daf grading, 80% of patients in our study had good-to-excellent results; 43 patients (86%) in our study had normal heel-toe gait after surgery; 15 patients developed inversion deformity of foot and 5 patients developed talonavicular collapse. CONCLUSIONThe usefulness of tibialis posterior tendon transfer as a method of correction of foot drop in leprosy is well known. In our study the gains of normal gait, favourable foot at rest position and active range of movement in the dorsiflexion range were improved after tendon transfer surgery. In the long-term evaluation of this procedure where the follow-up ranged from 2 to 10 years, tibialis posterior transfer functioned well and did not develop major surgery related complications like neuropathy, loosening of transfer by stretching of tendon or occurrence of new deformities. Apart from improving the gait, tibialis posterior transfer helped prevent recurrent ulceration in anaesthetic feet also.