S. Morita et al., TENDON TRANSFER FOR EQUINOVARUS DEFORMED FOOT CAUSED BY CEREBROVASCULAR-DISEASE, Clinical orthopaedics and related research, (350), 1998, pp. 166-173
Surgical correction was performed on 125 patients who had equinovarus
deformity caused by a cerebrovascular accident and who needed an ankle
foot orthosis for walking. The operative procedures involved anterior
transfer of the long toe flexors (flexor hallux longus and flexor dig
itorum longus; long toe flexor group) or lateral transfer of the anter
ior tibial tendon (anterior tibial tendon group), combined with length
ening of the Achilles tendon. On evaluation more than 2 years after su
rgery, 83 of 110 patients of the long toe flexor group and eight of 15
patients of the anterior tibial tendon group were able to walk withou
t a brace. Five patients of the anterior tibial tendon group who had s
hown strong contraction of the anterior tibial muscle during the swing
phase before surgery, needed a brace because of a drop foot after sur
gery. Thus, lateral transfer of the anterior tibial tendon was abandon
ed in 1984. Recurrence of varus deformity was seen in approximately 15
% of the patients in both groups. Anterior transfer of the long toe fl
exors, using them as dorsiflexor tendons or for tenodesis, seemed to p
roduce better results.