Treating Foot Drop: When Should I Consider Surgery?

Some unlucky patients have chronic foot drop, which is a weakness or the inability to lift up your ankle. Sometimes, foot drop can be treated with an AFO (ankle foot orthosis) brace, but if conservative treatments don’t work, you can consider surgery for foot drop.  

Many patients with permanent foot drop tolerate an AFO brace well, and those patients do not need surgery. 

When should I consider surgery for foot drop?

First, the root cause of the foot drop (nerve injury vs tendon injury), must be identified and treated. If you have a nerve injury, it is recommended to give the nerve 9-18 months to recover before considering a tendon transfer surgery. The recovery time depends on where the nerve is injured.  The recovery time begins after the nerve is treated. 

Once your medical team feels that your nerve recovery has made as much progress as possible, you can consider tendon transfer surgery. 

During recovery, it is important to keep the Achilles tendon stretched out, as a contracture can develop. A contracture is when a muscle/tendon becomes too tight. If the Achilles is too contracted, it may need to be surgically released or may prevent a patient from being able to have tendon transfer surgery. 

The orthopedic surgeons at Southwest Orthopedic Group can customize your treatment plan to determine if you are a good candidate for tendon transfer surgery. 

What is involved in foot drop surgery? What is tendon transfer surgery?

The purpose of the tendon transfer surgery is to replace the non-functional tendons in the front of the ankle.  The tendon transfer surgery is called a Bridle procedure.  During a Bridle procedure, the surgeon takes a tendon from the inside of the foot and moves it to the front of the ankle and foot.  Typically, a second tendon is taken from the outside of the leg and foot and moved to the middle of the ankle.  These tendons are sutured together to create a strong tendon construct.  Then, the tendons are secured into the foot, completing the tendon transfer surgery.

What is the recovery like after tendon transfer surgery?

Immediately after surgery, the patient is placed into a cast or a splint and is nonweightbearing.  At 2 weeks, the stitches are typically removed and the patient placed into a cast for a total of 6 weeks.  At 6-8 weeks post-surgery, the cast is removed and the patient is placed into a walking boot.  A night splint is used to protect the tendon transfer at night.  Patients attend physical therapy to work on motion and strength training.  The purpose of the surgery is for the patient to have improved position of the ankle and to be able to walk in a shoe without a brace.

What are the risks of tendon transfer surgery?

Every surgery has its own risks.  Aske your surgeon about your specific risks.

Will my ankle be ‘normal’ again?

Unfortunately, after a tendon transfer surgery, normal strength and motion cannot be restored. The goal of the surgery is to improve the resting position of the foot and ankle. Some patients can have some active lifting of the ankle. 

Can I walk without an ankle brace?

Many people can walk without a brace after surgery, but this is not possible for all patients. 

Can I pull up my toes after tendon transfer surgery?

The tendon transfer surgery does not address toe movement. If this is a concern, address it with your orthopedic surgeon. 

The American Orthopaedic Foot & Ankle Society (AOFAS) has more information about ankle fractures at FootCareMD.

For more questions or to set up an evaluation, contact Dr. Stautberg’s office at 281-977-4870. 

Author

Eugene Stautberg, MD