Tendon Transfer Surgery
TENDON TRANSFER SURGERY
TENDON TRANSFER SURGERY
A tendon transfer is moving a tendon from its normal, anatomic location to another area of the foot or ankle. Tendons typically are transferred in order to restore more normal movement to a foot and ankle that has lost function. A common problem is loss of the ability to raise the foot up, which is called foot drop. This can result from nerve or muscle damage due to stroke, injury, or other diseases. This muscular weakness or paralysis decreases movement and can lead to the foot becoming bent or twisted, making it difficult or painful to stand, walk or wear shoes.
Some tendon transfers allow the ankle and foot to move up and down and regain strength and motion. Others bring the foot into a position where it is easier to walk, stand and wear shoes, but will not increase range of motion. Realigning the foot and ankle can also decrease pain by more evenly distributing pressure across the foot. In some cases, a tendon transfer may eliminate the need for a brace altogether.
There are three requirements for tendon transfers to be successful. First, the muscle that the tendon is attached to has to be functional. It must contract at the proper time during walking. Second, the soft tissue through which the tendon is to be transferred needs to be as normal as possible. Large areas of scarring or skin damage can make it difficult to transfer the tendon. It also can prevent the tendon from gliding along the correct path. And third, the joints that the tendon crosses need to be both mobile and stable.
SURGERY
Tendon transfers involve the cutting of the tendon at its normal insertion, rerouting it through the soft tissues either around or between the bones of the foot and ankle, and connecting it to another bone in the foot. When the transferred tendon is long enough, it can be passed through a tunnel drilled through the target bone and then sewn to itself. The tendon also can be brought into a bone tunnel and fastened with a screw made of metal or an absorbable plastic. An anchor with sutures attached to it also can be placed in the bone at the point the tendon is to be attached and the sutures used to sew the tendon to the anchor. The soft tissues are then closed and the patient is placed in a splint.
COMPLICATIONS
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Sometimes the tendon transfer does not heal into its new position. The implant could break or loosen, or there could be progression of the original neurologic condition requiring further surgery.
FREQUENTLY ASKED QUESTIONS
Information provided by American Orthopedic Foot and Ankle Society (AOFAS) via FootCareMD.com