Fuhrmann Renée A, Wagner Andreas
Lehrstuhl für Orthopädie der Friedrich-Schiller-Universität Jena am Rudolf-Elle-Krankenhaus, Eisenberg, Germany.
Oper Orthop Traumatol. 2009 Dec;21(6):533-44. doi: 10.1007/s00064-009-2003-1.
Realignment of a fixed drop foot to restore gait pattern.
Drop foot due to various neurologic disorders (cerebral spastic palsy, traumatic nerve palsy, Charcot-Marie-Tooth disease) with/without dynamic equinovarus deformity and undisturbed function of the posterior tibial muscle-tendon unit.
Osseous deformities leading to drop foot, degenerative joint disease of the ankle, flexion deformity of the midfoot, scar adhesions around the muscle-tendon unit of the posterior tibial muscle, functional deficits of the posterior tibial muscle, ulcers, or soft-tissue damage.
Prone position: Z-shaped lengthening of the Achilles tendon and open arthrolysis of the posterior ankle and subtalar joint. Supine position: distal tenotomy of the posterior tibial tendon at the navicular. Exposure of the tendon proximally to the medial malleolus. Transposition of the tendon slip along the posterior tibial surface through the interosseous membrane to the distal lower leg. Further rerouting of the tendon beneath the extensor retinaculum to the midfoot. Reinsertion of the posterior tibial tendon to the second or third cuneiform bone.
Immobilization of the ankle in neutral position within a plaster or a walker for 6 weeks, followed by a rigid orthosis and physiotherapy.
Six patients (mean age 52 years) presented with a neurologic fixed drop foot deformity that had developed more than 8.3 years ago. After 12 months, five patients showed a neutral hindfoot position; one patient exhibited a plantar flexion of 5 degrees . Active dorsiflexion was limited in four patients (MRC [Medical Research Council] 2/5) and not visible in one patient. Total range of motion comprised 20 degrees (active) and 35 degrees (passive). During barefoot walking patients showed a regular swing phase of the concerned leg. Patients estimated the overall result as good or excellent.
矫正固定性垂足以恢复步态模式。
由各种神经系统疾病（大脑性痉挛性麻痹、创伤性神经麻痹、夏科-马里-图斯病）导致的垂足，伴/不伴有动态马蹄内翻畸形，且胫后肌腱单元功能未受影响。
导致垂足的骨性畸形、踝关节退行性关节病、中足屈曲畸形、胫后肌肌腱单元周围的瘢痕粘连、胫后肌功能缺陷、溃疡或软组织损伤。
俯卧位：跟腱Z形延长及后踝关节和距下关节切开松解术。仰卧位：在舟骨处行胫后肌腱远端切断术。暴露内踝近端的肌腱。将肌腱束沿胫后表面穿过骨间膜转位至小腿远端。进一步将肌腱在伸肌支持带下重新路由至中足。将胫后肌腱重新附着于第二或第三楔骨。
踝关节在石膏或助行器中固定于中立位6周，随后使用刚性矫形器并进行物理治疗。
6例患者（平均年龄52岁）呈现出8.3年多前形成的神经源性固定性垂足畸形。12个月后，5例患者后足呈中立位；1例患者有5度的跖屈。4例患者主动背屈受限（医学研究委员会肌力分级2/5），1例患者未见主动背屈。总活动范围包括20度（主动）和35度（被动）。在赤足行走时，相关腿的摆动期正常。患者对总体结果评价为良好或优秀。
