The Bridle Procedure for the Treatment of Dorsiflexion Paralysis of the Foot

Abstract

The Bridle procedure consists of a posterior tibial tendon transfer through the interosseus membrane to the dorsum of the foot to replace the loss of dorsiflexion paralysis with a triple insertion (a) bony insertion on the middle cuneiform bone, (b) tendon anastomosis to the anterior tibial, and (c) the peroneus longus tendons completing the Bridle effect on the paralyzed foot. The patient should have a prerequisite to a successful result: (a) full passive motion of the paralyzed foot in dorsiflexion, usually an Achilles tendon lengthening is done at the time of surgery, (b) no bony deformity of this paralyzed foot. If one exists, this should be appropriately corrected before the tendon transfer, and (c) significant strength of the posterior tibial muscle that will be transferred preferably a grade 4 or 5.