Transposición tendinosa del tibial posterior al centro del pie en lesiones neuromusculares. Experiencia en pacientes adultos / Adult experience with the tibialis posterior transposition to the center of the foot in neuromuscular disease

Resumen: La transferencia del tibial posterior al centro del dorso del pie es un método que se utiliza para lograr la dorsiflexión en parálisis flácida de la musculatura anteroexterna de la pierna o para contrarrestar el desequilibrio muscular del pie equino varo. Objetivo: Describir los resultados funcionales después del procedimiento quirúrgico de transposición del tibial posterior al centro del pie. Material y métodos: Estudio observacional, descriptivo, transversal y ambispectivo con una descripción del universo de trabajo en pacientes con deficiencia de la musculatura dorsiflexora del pie y afectación de la marcha en el período de Enero de 2008 a Diciembre de 2014. Resultados: Se obtuvo un total de 18 pacientes. Discusión: Creemos que este estudio podría considerarse como generador de hipótesis sobre si representa una alternativa superior a la artrodesis. Para ello proponemos continuar estudios en esta rama con mayor cantidad de evaluaciones en el preoperatorio y postoperatorio para obtener resultados más objetivos y con un grupo más amplio de individuos.

Abstract: The transfer of the posterior tibial tendon to the center of the dorsum of the foot is a method used to achieve dorsiflexion in flaccid paralysis of the anterolateral leg muscles or muscular imbalance of clubfoot. Objective: To describe functional results back to the surgical procedure for transposition of posterior tibial the center of the foot. Material and methods: The study design was observational, descriptive, transversal, ambispective with a description of the world of work patients with impaired dorsiflexora foot muscles and impaired gait in the period January 2008 to December 2014. Results: A total of 18 patients who were candidates for what this type of treatment was obtained. Discussion: We believe that this study can be estimated as generating hypotheses about whether it is a superior alternative to arthrodesis. For this plan to continue studies in this field, with an increased number of assessments both before and after surgery to have more objective results and a greater number of individuals.

Selective Neurotomy of the Tibial Nerve for the Treatment of the Spastic Foot: Case Report

When the spasticity becomes wevere and hamful, in spite of physical and medical therapy, surgery can give functional improvement. The authors report two cases of selective neurotomy of the tibial nerve for the treatment of the spastic foot which led to abnormal posture, articular limitation, pain, and disturbances impairing standing and walking. Prior to surgery, the effectiveness of neurotomy had been verified by means of infiltrating the nerves with local anesthetic agents. The surgery was performed under the intraoperative electrostimulation for identifying the branches of tibial nerve to the muscle sustaining spasticity. After microdissection of each tibial nerve brance at the lower part of the popliteal region, the selected branches were cut, preserving at least one fourth of the motor fibers. Significant functional gains were observed as a result of substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory function. For patients with disabling spastic foot, refractory to routine physical, orthopaedic and medical treatment a simple neurosurgical procedure, the selective tibial neurotomy has enabled them to stand and walk comfortably, and has allowed them to reach a significantly improved quality of life.