Two-tailed transfer of tibialis posterior for correction of drop-foot in leprosy.

Surgical correction of drop-foot in leprosy appears to have been neglected until Brand (1955) pointed out that anterior transposition of the tibialis posterior tendon to the intermediate cuneiform bone gave encouraging results. Since then there have been a number of reports of the use of this operation with or without modifications. Gunn and Molesworth (1957) reported fifty-six cases of drop-foot (fifty-four of them caused by leprosy) in which the tibialis posterior tendon was inserted into the tarsus after being brought forward through the interosseous membrane of the leg. They claimed satisfactory results in forty-nine cases, but did not specify their criteria for assessment. Selvapandian and Brand (1959) reported thirty-nine cases and claimed similar results. Andersen (1963, 1964) reported two series of cases. In the first series of 108 feet tibialis posterior transfer was done by four different methods. Excellent or good results were seen in seventy-two, and poor results in only six feet. The criteria for grading the results were not clearly mentioned in the paper. In his later paper Andersen reported twelve cases, with excellent or good results in eleven. In this series he used a fifth procedure, in which the motor tendon was rerouted round the tibia subcutaneously, looped round the tendon of extensor hallucis longus and secured to the tendons of extensor digitorum on the dorsum of the foot. The criteria for assessing the results were still not clear. In 1966 Thangaraj stated that he had done over fifty operations of a different type, in which the tibialis posterior tendon, brought anteriorly through the interosseous membrane, was inserted into the tendons of extensor digitorum longus and extensor hallucis longus in the anterior compartment of the leg. He apparently found the operation satisfactory, but he commented that the range of movement after this operation was poor compared to that obtained after the standard (Brand’s) procedure. Carayon, Bourrel, Bourges and Touz#{233} (1967) reported twenty-three cases of drop-foot (eighteen caused by leprosy) in which they had done dual transfer of the tendons of the tibialis posterior and flexor digitorum longus. These tendons were divided behind the medial malleolus and brought into the anterior compartment of the leg through the interosseous membrane. The tibialis posterior tendon was inserted into the tendon of tibialis anterior and the tendon of flexor digitorum longus into the tendons of extensor digitorum and hallucis longus, in the leg. The results were “ excellent “ or “ good” (active dorsiflexion of more than 5 degrees) in eighteen cases including thirteen sufferers from leprosy. It is clear that the tibialis posterior works well as a dorsiflexor when transposed forwards,