A new surgery that involves an expendable, functioning muscle from the medial side of the thigh and a nerve below the knee can give people with foot drop a new bounce in their step. Kevin Varner, MD, an orthopedic surgeon with The Methodist Hospital in Houston, Texas, and Michael Klebuc, MD, a plastic surgeon with The Methodist Hospital Institute for Reconstructive Surgery in Houston, combined their efforts to develop the procedure, according to a press release on The Methodist Hospital System news site.
Current foot drop therapies include wearing an AFO or a tendon transfer, which involves moving the tendon from the back of the leg to the front and re-routing tendon function. However, an AFO is often cumbersome, according to the press release, and the tendon surgery results in the foot being pushed down so people have to re-learn how to pull their foot up when walking. This new procedure, a complex operation called a functional muscle transfer, is an alternative to both therapies.
“We take the gracilis muscle from the inside of the leg, connect its blood vessels to the blood vessels in the leg and then attach its nerve to the peroneal nerve, which supplies movement and sensation to the lower leg, foot, and toes,” Klebuc explained.
The gracilis muscle is not a critical muscle in the leg. There are other muscles that are responsible for thigh adduction and knee flexion, so you can take this one out and continue to live a normal life. This surgery only works for injuries below the knee, the press release noted.
If all goes well, it takes about six months for the peroneal nerve fibers to grow into the transplanted muscle. At the end of this recovery time, people will be able to lift their foot and walk without a brace although the foot will not regain its pre-injury strength.
“This procedure is best for young, active people under age 50 with no atherosclerotic disease or other problems,” Klebuc said. “Keep in mind, the foot will not be as strong as it was before the injury, and playing sports like basketball and soccer will be nearly impossible. However, it will allow people with foot drop to walk without a brace, and for most, this is like winning the lottery.”
