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Author Topic: split posterior tibial tendon transfer for foot drop  (Read 27048 times)

Offline jcblank

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split posterior tibial tendon transfer for foot drop
« on: March 24, 2008, 05:52:19 AM »
does anyone have any information regarding a split posterior tibial tendon transfer for correction of foot drop?  I have been recommended for this surgery and would like to know any thing good/bad about it.
1995 menisectomy
9/06 menisectomy with resultant blood clot
6/07 meniscal transplant with peroneal nerve damage
12/07 peroneal nerve decompression

Offline Shaggy

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Re: split posterior tibial tendon transfer for foot drop
« Reply #1 on: March 31, 2008, 05:29:01 AM »
Sorry jcblank I have never heard of that.  Wish I could have helped.

Sheri
12/89 R knee scope for lateral release & patella shaving.
06/07 R knee scope for meniscus repair & bone spur removal.
08/07 R knee fluid removal & cortisone injection.
09-12/07 - R knee unloader brace and PT.
01/08 R knee HTO.

Offline jcblank

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Re: split posterior tibial tendon transfer for foot drop
« Reply #2 on: April 01, 2008, 05:06:34 AM »
The surgery takes a tendon in the back of your calf and splits it in half and attaches it to the front to hold your foot up.  The understanding I get is that you will have a functioning foot but you are using a different muscle to pull it up now.  It will also allow you to get rid of the AFO.
1995 menisectomy
9/06 menisectomy with resultant blood clot
6/07 meniscal transplant with peroneal nerve damage
12/07 peroneal nerve decompression

Offline Shaggy

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Re: split posterior tibial tendon transfer for foot drop
« Reply #3 on: April 02, 2008, 01:51:03 AM »
Wow what an interesting surgery.  Have you done any research on the website?  How long is the recovery time and what is the recovery like do you know?
12/89 R knee scope for lateral release & patella shaving.
06/07 R knee scope for meniscus repair & bone spur removal.
08/07 R knee fluid removal & cortisone injection.
09-12/07 - R knee unloader brace and PT.
01/08 R knee HTO.

Offline jcblank

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Re: split posterior tibial tendon transfer for foot drop
« Reply #4 on: April 05, 2008, 07:15:42 AM »
im still reading up on it.  i dont think it is a widely used surgery.  what i hear the results are pretty good.  the recovery time takes a while but worth it if it works.  as of now i have been waiting 10 months--im sure i could wait more if they think they could make my foot work.
1995 menisectomy
9/06 menisectomy with resultant blood clot
6/07 meniscal transplant with peroneal nerve damage
12/07 peroneal nerve decompression

Offline srcollin

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Re: split posterior tibial tendon transfer for foot drop
« Reply #5 on: April 10, 2008, 01:41:33 AM »
hi.  i was just wondering why you have a foot drop currently?  is it just weakness?  lack of ROM?  or is it due to a nerve paralysis that innervates the tib anterior?

Offline jcblank

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Re: split posterior tibial tendon transfer for foot drop
« Reply #6 on: April 11, 2008, 01:08:33 AM »
it is from nerve damage following surgery 10 months ago.  emg reveals no nerve impulses at all.
1995 menisectomy
9/06 menisectomy with resultant blood clot
6/07 meniscal transplant with peroneal nerve damage
12/07 peroneal nerve decompression

Offline cwalukevich

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Re: split posterior tibial tendon transfer for foot drop
« Reply #7 on: June 11, 2008, 06:35:56 AM »
I am 6 weeks post op. Was hoping to be in a walking cast today but bad news-I have to be non weight bearing for another 4 weeks. Then (maybe) I get the walking cast for 4-6 weeks (I hope!)
My surgeon says 3-6 months to "back to normal" is the recovey time. I am hoping to be able to get back to work at 12 weeks so I don't lose my job.

Good news is the foot is definitely more upright! Can't flex it yet but some flexion may come with  re-education of the tendon (read lots of PT) or it may just stay fixated. Four incisions all healing fine, minor bruising, swelling still in ankle and toes.

My foot drop was caused by nerve damage from a herniated disk in '06. Waited 20 mos. (while doing PT, elec. stimulation and wearing an orthotic) hoping for nerve regeneration but no luck. Thought about this surgery the whole time; took 2 mos. and 2 consults to finally do it. Day surgery; approx 2 hr surgery; home by 6 pm. Percocet for pain first week; weaned off that by end of week 2; switched to tramodol for another 1-2 weeks; now no meds and feel fine.

The only bad part is the long recovery-I hope I have a job after this because I need it haha!
Great surgeon (in Boston, MA). I have done more research post op than pre-op (think I was afraind to know too much in advance) and have some good articles if anyone needs them.

Feeling optimistic.....

schs71@yahoo.com :)

Offline jcblank

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Re: split posterior tibial tendon transfer for foot drop
« Reply #8 on: June 12, 2008, 06:21:56 AM »
cwal--you had actually email me a bit ago--good luck.  i am now 2 days prior to 12 months out from my damage.  still am having no dorsiflexion.  still not sure what the md will say when i go back to him in august--he was expecting me to be able to have dorsiflexion back in a few months from surgery--i had that done in december--so its not looking too good at this point.  still hoping
1995 menisectomy
9/06 menisectomy with resultant blood clot
6/07 meniscal transplant with peroneal nerve damage
12/07 peroneal nerve decompression

Offline davisesq212

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Re: split posterior tibial tendon transfer for foot drop
« Reply #9 on: September 27, 2008, 03:57:30 AM »
I had a posterior tibial tendon transfer in 2007 for a drop foot.  The drop foot was caused by a L5-S1 herniation.  First, I had a back surgery, then a knee surgery then a tendon transfer to help correct the foot drop.  I then had a follow up foot surgery.  I still use an afo.  If anyone has questions, feel free to email me.
2003 L5-S1 Discectomy
2006 L5-S1 Discectomy
2006 Left Knee Nerve Release
2007 Left leg Posterior Tibial Tendon Transfer
2007 Left leg Posterior Tibial Tendon Revision and Release
2009 Left Leg Posterior Tibial Tendon Transfer and Release with Dorsiflexion

Offline davisesq212

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Re: split posterior tibial tendon transfer for foot drop
« Reply #10 on: March 27, 2009, 03:14:47 AM »
I am 2 months post tendon transfer revision and just got the ok to start weight-bearing ever so slightly.  I am so excited.  My invitation stands...if anyone has questions, please email me.
2003 L5-S1 Discectomy
2006 L5-S1 Discectomy
2006 Left Knee Nerve Release
2007 Left leg Posterior Tibial Tendon Transfer
2007 Left leg Posterior Tibial Tendon Revision and Release
2009 Left Leg Posterior Tibial Tendon Transfer and Release with Dorsiflexion

Offline GILDEEPGILL

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Re: split posterior tibial tendon transfer for foot drop
« Reply #11 on: June 03, 2009, 08:07:53 PM »
can u pls let me know how r doing after ur surgery. since i had one recently mid may. still recovering.

Offline jove

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Re: split posterior tibial tendon transfer for foot drop
« Reply #12 on: June 16, 2009, 12:16:40 AM »
Hi. I had the posterior tibial tendon transfer (PTTT) for drop foot in Feb, 2009. Mine was not the "split" version, though. Mine was sutured to a metal anchor placed in the bone on the top of the foot.

Started PT at week 3. Was allowed to walk at 6 weeks, and was able to do so without needing the AFO any more. I could even wear my favourite sandals and walk. I was able to dorsiflex the foot through a small range, up to about the zero degree (horizontal) mark. This was great news, and the Dr. and I rejoiced mightily over our victory.

However, the war was not yet won.

The incision on top of the foot never healed. You could look down in there and see the sutures, and the tendon, and it was constantly draining a small amount of fluid. There were two attempts to re-suture the wound, but it opened up again each time ("dehisced"). The tendon became necrotic (starting to die off) from exposure. Last week (week 15 post PTTT) I had another surgery, skin graft and tendon repair (tendon wrapped with Graf-Jacket zombie-skin). So now I am back to non-weight bearing, in a splint, bandages, crutches for 3 -4 weeks.

Wish me luck.

I do not mean to discourage or frighten away anyone from this surgery. Perhaps I started too much PT and weight bearing, too soon (I was his 1st PTTT surgery). I don't know. Hope fully I can grow some skin over the wound before the tendon dies off, & then  resume  PT and walking again.

Offline Louis23

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Re: split posterior tibial tendon transfer for foot drop
« Reply #13 on: June 15, 2010, 11:33:12 PM »
Hi everyone. I'm bumping this because I have a foot drop issue due to a severe knee injury, in which ALL my ligaments were blown away. My knee is doing okay now, I am able to run through it. The problem is my foot drop that doesnt allow me to do much running, and which bothers me you know. I am set to have tendon transfer surgery, but the doctors didn't tell me much about it. I heard that it may take all my chances away to run and be an active person someday, and the goal of this is only getting the chance to walk normally without an AFO(orthese). I want to know how everyone is doing after the surgery, are you guys able to run? Is it true that there's no way you can run and the goal of this is only make you walk without the AFO? I don't want to take the surgery if that's the case, I'd rather take a chance at a nerve grephe or nerve transfer that will not damage anything else in my foot. I have been injured in football, in which I know I won't be playing again. But I haven't given up on running and playing a game like soccer for example. So, is this the best way for me to be an active man again? Or will it take all my chances away. I need answers because the doctors are so speechless and busy these days. I am 17 and was playing three sports before the accident, they said that I may never strecht my knee to 100 degree again and yet I hit 120 and I'm doing good now. I'm serious in physiotherapy, and have will to do everything it takes. Thanks for the responds in advance and sorry for the english mistakes, this is my second language.

Offline JoveJ

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Re: split posterior tibial tendon transfer for foot drop
« Reply #14 on: October 19, 2010, 10:19:57 PM »
Louis23;
In short, yes I  had the Posterior tibial tendon transfer (PTTT) and yes I could jog. More of a slow jog than a full-out run; but then I am 55 years old.

I had the PTTT in Feb. 2009. (NOT the 'split' version) Wound healing and infection issues kept me from any serious exercise or workouts for 7 months, during which time I had 2 more outpatient surgeries ((1)drain the infection (2) skin graft) under MAC anaesthesia, and twice a week wound care (debridement). Finally I had a series of APG (autologous platelet graft) which closed the wound finally Sept. 2009.

Then (Sept. 2009) I was able to start working out again (swim, bike, yoga, weights) and by Dec. 2009 I could jog a little bit. Continued to work out, then by July 2010 I was doing hard work outs ( Muay Thai boxing ) and could jog a mile or two almost daily. However, my tendon transfer did not result in a well- balanced foot, so I cannot jog much more than 1 mile or 2 before the excess pressure on the edge of my foot starts to hurt. ( My PTTT was NOT a 'split' transfer, however. Note that there are many different versions of the procedure.....)

But then, by Sept. 2010  I had developed an inclusion cyst over the transfer site. The inclusion cyst ruptured and became infected, so I had to have more surgery to remove the cyst. Also, the transferrred tendon was partly necrotic (dead) and had to be trimmed and re-inforced. So I again was not able to exercise at all for a month or so. I am now in PT and things look pretty good, so soon I hope to get back to jogging and a more strenuous exercise program soon.

Is it worth it? Well that remains to be seen. I can walk and jog with out the AFO, if I have good athletic shoes on. Barefoot, it hurts to walk on cement or tile because of the foot imbalance and my toes still droop. Running in soft sand, or rough ground, is no good at all because my ankle is too weak. But limited jogging on level ground is OK.

I would still seriously consider having the PTTT surgery (if I had to do it all over again) but would be more careful in selecting the surgeon. (I was the first PTTT that my surgeon had ever done). Find some one who has done several of these, and ask them what their complication rate has been. Perhaps someone who has done several of these would have fewer complications resulting.

 















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