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Footdrop is a debilitating ankle condition that may result from muscle deficiency in the anterior compartment of the leg. Patients typically complain of impaired walking caused by inability of foot dorsiflexion and supination. The main causes of footdrop are traumatic injury; neurologic conditions; and muscular deficiency, including poliomyelitis, cerebral palsy, stroke, multiple sclerosis, amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease, and unrepaired muscle and nerve injuries. Physiotherapy can be useful for the management of initial phases of footdrop or for patients in whom surgical treatment is not possible. Surgical treatment options include tenodesis, arthrodesis, and tendon transfers.

This video discusses the posterior tibialis tendon transfer technique for the management of footdrop secondary to insufficiency of the muscles in the anterior compartment of the leg. We retrospectively evaluated 13 patients (eight men and five women) with footdrop who underwent posterior tibialis tendon transfer. Mean patient age was 34.8 years (range, 16 to 59 years). Footdrop was caused by a nerve injury, trauma, or surgical procedure in nine patients (69.2%). Two patients (15.4%) had Charcot-Marie-Tooth disease, and two patients (15.4%) had myelomeningocele. Indication for posterior tibialis tendon transfer was the presence of a reducible footdrop caused by loss of extensor muscle function and a functioning (at least 4/5) tibialis posterior tendon. In all of the patients, the posterior tibialis tendon was transferred onto the intermediate or lateral cuneiform (depending on the degree of forefoot varus), pulled out through a transosseous tunnel, and fixed at the plantar surface. Achilles tendon lengthening was performed before posterior tibialis transfer in seven patients. Postoperatively, a non–weight-bearing cast was applied with the foot in a neutral position, after which a weight-bearing ankle-foot orthosis was applied with the foot in a neutral position for additional 30 days.

Mean postoperative follow-up was 24.38 months (range, 16 to 30 months). Clinical results were evaluated using the Stanmore scale and the American Orthopaedic Foot and Ankle Society ankle-hindfoot score at 30 days postoperatively, 3 months postoperatively, and 6 months postoperatively and yearly thereafter. According to the Stanmore scale (scale range, 0 to 100), five patients (38.4%) had an excellent outcome, five patients (38.4%) had a good outcome, two patients (15.3%) had a fair outcome, and one patient (7.6%) had a poor outcome. The mean Stanmore scale score was 78.9 (good outcome). The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 54 preoperatively to 72 at latest follow-up. No major complications were observed. Two patients reported temporary discomfort caused by a protuberance on the dorsal surface of foot at the site of the transfer. The review of our personal case series has shown satisfactory results. The surgical technique described is a simple, costless, effective, and reliable procedure to achieve a more functional foot and to retrieve active dorsiflexion in patients with footdrop.