Tendon transfer in foot deformity

partial tendon transfer of tibialis anterior

Common causes of foot deformity are polio, cerebral palsy, meningo-myelocoel, CTEV, nerve injury. If this deformity is because of muscle imbalance then it will need tendon transfer along with correction of deformity. Chance of recurrence of deformity became lesser by the use of tendon transfer. We utilize the tendon from remaining muscle in extremity that after transfer do not interfere much in important function of limbs. Selection of tendon is very important during surgery. Power of transferred tendon should be Grade 5 but never less than 4 because after transfer power may decrease upto 1 grade and it should in same direction of pull of weak muscles. 

you tube link to few cases with tendon transfer 

We can utilize complete or half of tendon in transfer. Half tendon transfer are being utilized commonly in cerebral palsy & ctev affected foot. In ctev & cerebral palsy we utilized half tendon of tibialis Anterior to lateral side of foot to balance over action of forefoot inversion and half tendon of tibialis posterior in hind foot inversion of cerebral palsy foot . In foot drop, we transferred tibialis anterior to mid portion of foot and in calcaneous foot we transfer peronie & inverter muscle posterior toward insertion of tendoachilis. After tendon transfer, foot will be protected with plaster for 1 month and then with brace. Vigorous therapy can be started after 6 week and child will to walk after 2 month with brace. Person has to wear brace minimum 3-4 months.

 

for more information contact

Dr Jitendra kumar Jain

pediatric orthopedic surgeon cum foot surgeon

www.trishlaortho.com & www.trishlafoundation.com

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Management of hand problem in cerebral palsy by tendon transfer and SEMLOSSS

IMG_1358   IMG_2314

Upper extremity involvement in cerebral palsy interferes with proper use of hand and it is most challenging for therapist and surgeon to deal with it. In upper extremity they can have problem in shoulder, Elbow, wrist, and fingers. Problem can be of combination of lifting of upper limb above the shoulder, reaching out to object or not able to perform fine activity by hand.  It is also very important that preference of hand became fixed at the age of two year so it became imperative to start therapy at earliest to get maximum outcome before the age of 2-3 year age.  We have many ways of therapy for hand like Bimanual, CIMT, sensory integration & proper occupational therapy. Affected hands in cerebral palsy have manifold problem like weakness, spasticity, contracture & sensory problem.  Most difficult to treat problem in upper limb is non recognition of fine motor activity by cortical center in brain so that they are not able perform activity at their own in coordinated manner. Most important problem that interferes in therapy is contracture and spasticity in extremity that is too being managed at early. In early age (2-5 year), it can be managed by botulinum toxin but child develop fixed contracture then they require surgical intervention. earlier we use to do tendon lengthening of all affected tendon require long rest of hands and rehab can be started after months and recovery was not so good every time. But with the new concept of OSSCS & SEMLOSSS we use to relieve spasticity & contracture by aponurotic (facial coverage at musculo-tendinous junction) release by this technique we can start therapy early and child regain function in very short time. Some time these children also have weakness in few group of muscle so we also utilized the concept of tendon transfer. This tendon transfer help in regaining muscle power and good functional recovery.

Video of outcome of tendon transfer in cerebral palsy affected hand of few children & adolescent

few children It is very important to continue therapy for log duration till complete recovery. Child should wear brace as advised their operating surgeon and therapist concerned. By use of all this modality we can give good functional recovery to child.

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