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foot drop treatment

've had foot drop for 13.5 years due to having been in a hospital bed for 2 months. I have MS and my doctors and physical therapists have tried everything and nothing has been successful. I read an article about Functional muscle transfer for foot drop. Is that really a treatment for foot drop?
Poster
  • Complaint duration: 90 days
  • Medications: Aubagio
  • Conditions: Multiple Sclerosis

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There is a surgery that will hold your foot in a functional position so that you are less likely to trip. It involves transfer of a functional muscle and tendon (tibialis posterior) from the back of the ankle to the top of the foot. It is more of a "tenodesis," in that the foot is held in a relatively static position, allowing passive dorsiflexion and plantar flexion. There is maintenance of active plantar flexion but active dorsiflexion may be somewhat limited. Some patients may still require brace (AFO) wear. Some patients gain significant active dorsiflexion, although this is difficult to predict and is dependent upon a functional tibialis posterior muscle. Results may diminish over time, especially in the face of progressive nerve dysfunction, such as one might experience with MS.
james mcwiliam
Surgery is always an option but should be your last option. Conservative treatments consist of brace on affected side. Ms is a progressive disease so it has a lot of treatment options. Best of luck
Alex Kheynson
Dropfoot problems in someone with MS can be a challenging clinical entity to treat. Muscle transfers can be considered, but often would require additional procedures such as fusions of multiple joints. With MS, there may be weakness of multiple muscle groups, therefore, there may not be a viable option of a tendon to effectively transfer. Such operations are major undertakings and would require prolonged cast or splint immobilization plus not bearing weight on the foot for 2-3 months or more. The overall health and age of the patient should also be taken into consideration. A podiatrist or foot and ankle orthopedic surgeon trained and board-certified specifically in reconstructive foot and ankle surgery would be your best options to seek an opinion. A good surgeon should is also one who knows how to do the procedures well but when surgery is not the best option for the specific patient. There are a variety of newer custom brace options referred to as AFO braces (Ankle and Foot Orthosis) that are available that have hinges or other devices to improve function and stability and may be considered if your other doctors have not already tried them.
Yes, it is really a treatment for dropfoot, however, the muscle being transferred has to be a functioning muscle group (ie. Posterior tibial muscle). Normal strength and function will never be obtained but may negate the need for a brace.
Seth Steber
A proper evaluation of the entire limb is needed. I broadly classify the problem into one that is braceable or non-braceable. Release of contractures alone with a brace may be a viable treatment. When muscles are transferred they will weaken, if they are weak then they function as a tether that will allow for household ambulation without a brace. If the foot is turned inward, then a "bridle" procedure combined with selective joint fusions may provide you with a foot that you can walk on with a normal shoe, however all of this is dependent upon a proper evaluation of the current muscle strength and joint mobility. I would advise an evaluation by a MD orthopedic surgeon with subspecialty training in foot and ankle reconstruction.
David Kay
There are 'functional' and 'supportive' tendon transfers that can significantly help with drop foot. Having MS may be a contraindication for a 'functional' transfer, but the muscle groups will have to be evaluated by your physician/surgeon. But a STATT (Split Tibialis Anterior Tendon Transfer) procedure may work in people with severe motor deficiency. It would be best for you to discuss this with a qualified Podiatrist in your area who is trained in reconstructive rearfoot/ankle surgery.
It is a very delicate situation requiring much thought. I have never seen that surgery, but I know it is discussed. You need to see a top notch foot and ankle surgeon to see if you are a candidate. Another option could be an ankle fusion and then to use rocker sole shoes. I am assumming you have had some success with AFOs. Dr Rich Blake
Richard Blake
I am not familiar with functional muscle transfer. What I can tell you is that muscle must be constantly stimulated by nerve impulses. If nerves are damage, muscle will atrophy ( loose strength and become smaller). Given you have MS I would think nerve innervation to muscle is compromised, no muscle transfer under this condition would succeed.
Tendon transfer procedures are generally successful, but require a great deal of post-operative rehabilitation. You should first consult with a podiatrist and get an evaluation for a custom ankle-foot orthotic. When fabricated properly and worn correctly, will deliver the same results without any possible surgical complication.
Yes it is. You need to see A foot and ankle Orthopaedic surgeon specialist to determine if you're a good candidate for the procedure. The tendon flexor is transferred to make your foot hold up so your foot doesn't drop down.