Single versus double tendon transfer for foot drop due to post-traumatic common fibular nerve palsy

To compare functional outcomes of single versus double tendon transfer for foot drop correction and toe drop prevention in posttraumatic common fibular nerve palsy.

A retrospective study was conducted on data from patients with posttraumatic common fibular nerve palsy treated by tendon transfer between 2001 and 2018. In cases of single tendon transfer (STT) the tibialis posterior (TP) tendon was transferred anteriorly through the interosseous membrane to a new insertion on the lateral cuneiform. In cases of double tendon transfer (DTT), the same TP tendon transfer was combined with a transfer of the flexor digitorum longus to the extensor digitorum longus and extensor hallucis longus tendons. Functional assessment was based on the Carayon score to evaluate foot drop correction and on the Yeganeh score to evaluate toe drop prevention.

A total of 27 patients were included: 13 in the STT group and 14 in the DTT group. Functional results were comparable between groups in terms of reduction of foot drop, active range of ankle motion and Carayon score. Prevention of toe drop, active toe extension and Yeganeh score were significantly greater in the DTT group, however, active toe extension of was only restored in only 8 cases in the DTT group.

Double transfer of TP and FDL tendons is a reliable method to restore balanced ankle dorsiflexion and prevent toe drop. However, recovery of active toe extension was inconsistent and Carayon scores were not superior to those obtained with a single TP tendon transfer.