Bridle Procedure for the Treatment of Foot Drop - Standard (Feat. Dr. Johnson)

Bridle Procedure for the Treatment of Foot Drop - Standard
Authors: Johnson JE1, Yee A2
Published: November 4, 2016

AUTHOR INFORMATION
1 Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Peroneal nerve injury is a frequent neuropathy in the lower extremity and injury to the common peroneal nerve presents with foot drop and steppage gait. This results in the functional loss of the anterior and, often, lateral compartment musculature of the leg. There has been limited success with nerve transfer for foot drop and the standard operative restoration of dorsiflexion in patients with peroneal nerve palsy is dynamic tendon transposition. The Bridle procedure for foot drop is a modification of the tibialis posterior tendon transfer that includes a tri-tendon anastomosis with the tibialis anterior and transposed peroneus longus. This procedure was designed to create balanced attachment points with the addition of these two tendons for a more even distribution of pull on the dorsum of the foot, thereby avoiding a varus or valgus deformity from tendon overpull. This modification often avoids the need for a triple arthrodesis or other procedure to stabilize the foot in neutral. Also, many patients complain of "ankle instability" in addition to the lack of active ankle dorsiflexion. The two additional attachment points of the transfer improves the stability of the ankle in the coronal plane. In this case, a 65-year-old female presented with bilateral lower extremity neuropathy and has a complicated and unusual history. She previously underwent a L4-5 fusion and unfortunately continued to have progressive motor weakness in both lower extremities. Electrodiagnostic studies indicated a severe right peroneal neuropathy without residual or recurrent lumbar radiculopathy and with no fibrillations or motor unit potentials. On clinical examination, she had a foot drop gait with MRC 5/5 motor strength in the tibial-innervated muscles, which included the posterior tibialis muscle, but 0/5 anterior compartment and 3/5 lateral compartment strength. The patient was managed with a Bridle procedure for treatment of right foot drop. This video demonstrates the technical nuisances of this procedure, however does not include specifics for gastrocnemius/soleus lengthening as the patient passed the Silfverskiold's Test for contractures that are typical in patients with foot drop.