Special Focus: Updated Techniques for Tendon Transfers of the Foot and AnkleThe Bridle Procedure for the Treatment of Dorsiflexion Paralysis of the FootRodriguez, Raoul P. MDAuthor Information Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA No support or funding was used for this paper. Address correspondence and reprint requests to Raoul P. Rodriguez, MD, Professor and Chairman, Orthopaedics SL32, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112-2699. E-mail: [email protected]; [email protected]. Techniques in Foot & Ankle Surgery: December 2009 - Volume 8 - Issue 4 - p 168-171 doi: 10.1097/BTF.0b013e3181c24c38 Buy Metrics 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. © 2009 Lippincott Williams & Wilkins, Inc.