Peroneal tenodesis procedure for paralytic foot

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Peroneal tendon identified  

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both tendon brought out

Paroneal tendon laid out


Paroneal tendon brought subcutaneous to skin

Fixed to bone via sutures

cast applied to foot
foot paralysis is debilitating condition. It results in high stepping gait. It alters gait ,reduces walking speed. Some people adapt very well to it. Foot goes into inversion and excessive pronation. There is always instability of foot . Climbing stairs is difficult . Patient has a high stepping gait. Walking speed is reduced.
Causes
Spinal cord injuries both traumatic and iatrogenic
Nerve injuries traumatic and various neuropathy
Loss of muscle due trauma and myopathy

Treatment
As presentation is variable due to various causes, treatment is tailored according to it.

Splints and physiotherapy
Splints help in keep joints mobile and prevent developing contracture. It certainly help patient to walk better.

Posterior tibialis tendon transfer
It is helpful when when lateral peroneal nerve is damaged. While doing this transfer I usually attache both peroneal tendon and anterior tibialis tendon to transfer to make a hammock like sling and stabilize foot.

Peroneal Tenodesis procedure
This procedure is basically inspired by a Evans procedure which is done for damaged fibular navicular ligament. I usually do it for cases which has lost both anterior muscle function and posterior muscle function.Good foot sensation is mandatory.
Both peroneal tendons are cut at mid calf level and brought to foot and in a subcutaneous route  brought to shin. You can fix both peroneal tendon to anterior surface of tibia by variety of means sutures, screw button etc. A cast is applied at completion of  surgery for six weeks. Patient is encouraged to walk next day. A pressure garment can be given to reduce swelling in a paralytic limb after six weeks for three months. This procedure is just  a form of internal splinting useful in total paralytic limbs and stabilizes foot while walking , Posterior tibialis tendon transfer can't be done in such circumstances.

In last five years I have done 10 cases all patients reported improvement in foot position and improved walking and are generally happy with it. delayed wound healing and swelling are the issues we are faced with.

Dr Adhishwar Sharma +91 8860650846
adhishwar7@gmail.com









14/2/2018
These are two video send by old patient operated in 2015 in Metro hospital Faridabad. Patient had total sciatic nerve palsy secondary to trauma and it was four years old. He had gradually recovered sensation in foot , he was offered this procedure which he accepted and was operated. As can be seen in video walk is reasonable okay and though not much foot movement. Patient is very satisfied from surgery because disability is gone and walk is improved.


Dr Adhishwar Sharma 8860650846, adhishwar7@gmail.com

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