Foot drop surgery
Foot drop surgery
Foot drop surgery
Foot drop surgery
What is foot drop?
If so, you have foot drop (aka drop foot), and it’s caused by weakness or paralysis of the muscles that pick up your foot.
Causes of foot drop
Conditions that affect the brain and spinal cord, such as stroke, multiple sclerosis, and damage to the spinal cord or nerve roots (such a slipped disc, or spinal stenosis), may cause foot drop.
Sometimes damage to the peripheral nerves that power the muscles in our lower legs, e.g. the sciatic nerve or peroneal nerve can result in foot drop. This might occur because of fracture in the location of the nerve, wearing a cast that compresses the nerve, but it can also be a complication of hip replacement and spinal surgery.
Some patients acquire foot drop as a result of a peripheral neuropathy or motor neuron disorder, and other neurological disorders (e.g. Charcot Marie Tooth disease).
Significant damage to the tendons that pull your foot upwards (e.g. the tibialis anterior muscle) can also cause foot drop.
Foot drop treatment
Not all foot drop is permanent, but in many cases it is. If wearing a brace (e.g. an ‘AFO’- ankle foot orthosis) to support your foot and ankle isn’t helping you, then you might benefit from foot drop surgery.
Foot drop surgery that involves tendon transfer requires that you must have some working muscles in your lower leg. If this is not the case, you may still be suitable for ankle fusion surgery.
Tendon transfer for foot drop
When a muscle (or the tendon of that muscle) isn’t functioning and can’t lift the front part of the foot, surgery can be carried out that enables other tendons and muscles to do that job instead.
Everyone’s requirements are unique, but often the surgery will involve a posterior tibial tendon transfer, and this may be done in combination with a peroneus longus and tibialis anterior tendon transfer – known as a Bridle procedure.
In essence this is a surgery that cuts and re-routes the functioning tibialis posterior tendon, through to the front of the foot. Multiple small incisions are made to transfer the tendon from one position to another. Other tendon transfer options can be employed, and fusion surgery is also sometimes required.
Sometimes tendon transfer surgery is carried out along with surgery to realign the heel bone (calcaneal osteotomy), or a midfoot fusion.
What’s the recovery like after foot drop surgery?
The surgery takes place under general anaesthetic or a spinal anaesthesia, and when you wake up, you’ll have plaster cast on your leg, which you’ll keep on for 6 weeks. It’s important that you keep your leg elevated for these first couple of weeks, to minimise swelling and aid healing.
At 3 weeks, the cast will be removed, and I’ll check the wounds and remove the stitches. You’ll then go into a weight bearing cast for a further three weeks, and then you can start physiotherapy. Most patients are fully active by 3 to 4 months. Some patients might still need an orthotic after the surgery, but it should be easier to wear.
