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Distal Nerve Transfers for Foot Drop: A Systematic Review and Meta-Analysis.

J Terrence Jose Jerome1,2, G Surendran3, Thirumagal Kuppusamy2

  • 1Department of Orthopedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India.

Microsurgery
|January 27, 2026
PubMed
Summary
This summary is machine-generated.

Distal nerve transfer (DNT) can restore dorsiflexion in about half of patients with foot drop, with one-third achieving near-normal strength. Early surgery and healthy anterior compartments improve outcomes.

Keywords:
deep peroneal nervedistal nerve transferdorsiflexionfoot dropneurotizationperoneal nerve palsytendon transfertibial nervetibialis anterior

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Reconstructive Surgery

Background:

  • Peroneal nerve palsy causes foot drop, leading to steppage gait and functional disability.
  • Tendon transfer is a common treatment but alters natural biomechanics.
  • Distal nerve transfer (DNT) offers a potential alternative to reinnervate dorsiflexors and restore physiologic function.

Purpose of the Study:

  • To systematically review and meta-analyze clinical outcomes of DNT for foot drop.
  • To identify prognostic and technical factors influencing DNT success.
  • To inform current reconstructive surgery decision-making for foot drop.

Main Methods:

  • Systematic review and meta-analysis following PRISMA guidelines.
  • Searched MEDLINE, EMBASE, and Cochrane databases for studies on DNT to the deep peroneal nerve (DPN).
  • Pooled proportions of patients achieving Medical Research Council (MRC) grade ≥3 and ≥4 dorsiflexion were estimated using random-effects meta-analyses.

Main Results:

  • Ten studies (120 participants) were included; 7 clinical series (101 participants) provided extractable data.
  • Pooled proportion achieving MRC ≥3 dorsiflexion was 57% (95% CI 0.41-0.72).
  • Pooled proportion achieving MRC ≥4 dorsiflexion was 33% (95% CI 0.12-0.58); low donor site morbidity was observed.

Conclusions:

  • DNT restores antigravity dorsiflexion in approximately 50% of selected patients, with 33% achieving near-normal strength.
  • Optimal outcomes are associated with early surgery (≤12 months) and viable anterior compartments.
  • Tendon transfer remains a viable option and can be combined with DNT in complex cases.