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  • Failed Posterior Tendon Transfer Surgery

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    Old 12-21-2016, 07:05 AM   #1
    MarkX45
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    Failed Posterior Tendon Transfer Surgery

    I suffered complete permanent foot drop in my left foot after a back surgery in 2002 when I was 34 (I am 49 now). I've managed it with braces for nearly 15 years, but developed achilles tendonitis and went to several local doctors. One surgeon in my town performed the Posterior tendon transfer surgery that could raise my foot back to neutral and, hopefully, allow some dorsiflexion. He had performed 25 cases or so, and said they had all been successful.

    I had the surgery in February 2016, but when I got out of the cast and the walking boot, I was not able to dorsiflex at all. My foot was in a better position than before surgery, but it wasn't neutral. After some time the Dr. ordered an MRI and this told him that my transferred tendon had somehow become detached. He performed the surgery again in June 2016, and kept me in the cast nearly twice as long to try to keep the tendon in place.

    After the cast came off I had developed an infection where the suture came out of the bottom of my foot- It delayed PT for a month, but on my own he told me I could work on dorsiflexion. It was exactly the same as the first time- no lift to my foot at all- again it was still in drop foot, but not as far down as before. He started me on physical therapy in October, but the PT's weren't able to improve anything, there is literally no movement in the foot other than the other little muscles that don't lift it, just a tiny wiggle to the toes (other than the big toe, which doesn't budge). I finally persuaded the Dr. to give me another MRI. He said it showed the tendon is intact, and he speculated that either a "stretched out tibialis posterior muscle" or scaring is preventing the foot from lifting. The muscle was tested and strong before surgery, and the PT's said they saw no evidence of scaring on the foot incisions (although who knows whats going on deep in the ankle area).

    I knew sometimes a patient doesn't get any dorsiflexion from the surgery, but I thought my foot would at least be held in neutral, but I am still at -35 degrees, which means I still have to wear a brace and received no benefit at all from the surgery- in fact now my tibialis posterior is useless to me, so I'm worse off now than i was a year ago.

    Anybody have any suggestions?

    Last edited by Administrator; 12-27-2016 at 09:51 AM.

     
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    Old 12-21-2016, 05:48 PM   #2
    Pheslie
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    re: Failed Posterior Tendon Transfer Surgery

    I did not have my surgery yet but look at Hospital For Special Surgery NY and check to see who specializes in this.

     
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    Old 12-24-2016, 08:45 AM   #3
    MarkX45
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    re: Failed Posterior Tendon Transfer Surgery

    Thanks very much I will

     
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    Old 12-24-2016, 09:07 AM   #4
    kath9033
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    re: Failed Posterior Tendon Transfer Surgery

    Do you have complete/partial nerve damage in your anterior tibialis? Transferring a tendon isn't going to do anything strength wise because it's not a muscle. Tendons just connect muscles to bones, muscles do motion. So in theory, it may provide structural stability to keep your foot in a somewhat better position/as close to neutral as possible. But with the tug and pull between your anterior tibialis and your gastrocnemius (calf muscle), it'll stretch out whatever work they do if they're using tendon tissue as a graft. If they use non-biological tissue (like a weaved medical grade mesh wire) to get the foot in a more neutral position, I can see that helping more so than the other technique. Unfortunately there's only so much technology when it comes to nerve damage and it takes years for nerves to regenerate (to the extent that they can) after the initial injury.

    I can related to an extent. I had back surgery September of 2015 and ended up with an L5 nerve root injury due to the surgeon over stretching it or possibly even nicking it. This has caused me to have nerve damage in my anterior tibialis and Peroneal muscle group. So I have functional foot drop. I have to wear an AFO as well, that is a little more heavy duty than the run of the mill braces. It allows absolutely no movement of the ankle in all directions. My back is still not resolved, I still have nerve damage, and am in extreme pain on a daily basis. It's absolutely horrible. It's great you have the capability to travel and see whatever doc you want. I have to deal with workers comp since it happened while lifting a patient. I hope things work out, and I hope I didn't sound like a negative nancy. I just wanted to be realistic with my thought process and provide an unbiased point of view. Please keep us updated and good luck.

    Last edited by Administrator; 12-27-2016 at 09:57 AM.

     
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    Old 12-27-2016, 05:33 AM   #5
    MarkX45
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    re: Failed Posterior Tendon Transfer Surgery

    I do have nerve damage that affects my anterior tendon but you are incorrect that moving the posterior tibialis tendon isn't going to do anything strength wise that can effect my dorsiflexion. You are correct that a tendon is not a muscle, but a tendon is attached to the muscle. Moving the tendon should, in theory, mean that a contraction of the tibialis posterior muscle (which is attached to the tendon) will dorsiflex the foot. This isn't a question of nerve regeneration, but more moving a tendon from the back of the leg to the front so that the attached muscle in back can do the work the damaged muscle in the front of the leg can't do on its own.

    It is a surgery done by 100's of doctors across the country. In my case, however, it is not working correctly.
    Best of luck to you!

    Last edited by Administrator; 12-30-2016 at 10:14 AM.

     
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    dorsiflexion, drop foot, ptt, tendon transfer



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