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Clinical Results of Transferring a Motor Branch of the Tibial Nerve to the Deep Peroneal Nerve for Treatment of Foot Drop

Flores, Leandro Pretto MD, PhD†,‡; Martins, Roberto Sérgio MD, PhD§; Siqueira, Mario Gilberto MD, PhD§

doi: 10.1227/NEU.0000000000000062
Research-Human-Clinical Studies: Editor's Choice
Editor's Choice
CNS University of Neurosurgery

BACKGROUND: Foot drop is a very debilitating condition affecting patients' daily activities, and its treatment has been a challenge for neurosurgeons. Grafting the peroneal or sciatic nerve usually results in poor outcomes. Our previous anatomic study demonstrated the feasibility of transferring a motor branch of the tibial nerve to the deep peroneal nerve at the level of the popliteal fossa.

OBJECTIVE: To demonstrate the outcomes obtained after the transfer of a branch of the tibial nerve to the peroneal nerve for recovery of foot drop.

METHODS: A retrospective review of 13 patients with foot drop caused by injuries to a lumbar root or the sciatic or peroneal nerve, who underwent a transfer of the nerve of the soleus muscle to the deep peroneal nerve. The results were evaluated using the British Medical Research Council grading system.

RESULTS: Three patients were lost to follow-up. Of the remaining 10 patients, the outcomes were considered good (Medical Research Council grade M3 or M4) in 2 patients (20%) concerning ankle dorsiflexion and in 2 patients concerning toe extension (20%). One patient reported a reduced calf circumference.

CONCLUSION: The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.

ABBREVIATION: MRC, Medical Research Council

Unit of Neurosurgery, Hospital de Base do Distrito Federal, Brasília, Distrito Federal, Brazil;

Hospital Santa Helena, Brasília, Distrito Federal, Brazil;

§Peripheral Nerve Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil

Correspondence: Leandro Pretto Flores, SHIN QL 07 Conjunto 01 Casa 18, Lago Norte, Brasília, Distrito Federal, Brazil 71515015. E-mail:

Received November 21, 2012

Accepted June 20, 2013

Copyright © by the Congress of Neurological Surgeons