Dr. David Gitlin has significant interest in the treatment of footdrop (or dropfoot if you prefer to spell it that way). We realize that this is a very difficult condition to live with since it severely alters a persons walk and we also realize that the braces commonly prescribed do not do a very comfortable job correcting the foot.
Over the past 10 years Dr. Gitlin has transferred every muscle in the lower leg and ankle to correct this condition. Why 'every muscle'? Because every case is unique, depending on the cause of the dropfoot, different muscles may be injured and nonfunctional so using different muscles and tendons may be necessary. If you search and read online you will find the posterior tibial tendon transfer is probably the most common procedure used- but many times other tendons must be either lengthened or shifted at the same time. Every patient is assessed in a very particular way to find which muscles- if any are functional and movable and where they should be moved to for the best possible outcome.
We have two publications submitted for research journals with two new tendon transfer techniques never performed before. At Mount Sinai Beth Israel we are also conducting a landmark study using EMG muscle testing and EEG brain wave monitoring to help assess pre op surgical planning and post op muscle training, this study to be completed and submitted for review and publication in orthopedic journal in early 2017.
Foot drop describes the inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot. As a result, individuals with foot drop scuff their toes along the ground or bend their knees to lift their foot higher than usual to avoid the scuffing, which causes what is called a “steppage” gait. Foot drop can be unilateral (affecting one foot) or bilateral (affecting both feet). Foot drop is a symptom of an underlying problem and is either temporary or permanent, depending on the cause.
Causes include: neurodegenerative disorders of the brain that cause muscular problems, such as multiple sclerosis, stroke, and cerebral palsy; motor neuron disorders such as polio, some forms of spinal muscular atrophy and amyotrophic lateral sclerosis (commonly known as Lou Gehrig’s disease); injury to the nerve roots, such as in spinal stenosis; peripheral nerve disorders such as Charcot-Marie-Tooth disease or acquired peripheral neuropathy; local compression or damage to the peroneal nerve as it passes across the fibular bone below the knee; and muscle disorders, such as muscular dystrophy or myositis.
At our office we utilize the most current invasive and conservative techniques for dropfoot correction. To date we have performed all combinations of tendon transfer, joint fusion, and bone osteotomy to allow the patient to ambulate as normal as possible. Most times postoperatively no one can tell the patient ever had a dropfoot condition at all. We also understand that surgery is not for everyone and use nerve stimulation, physical therapy, and bracing as well to manage the dropfoot. We work closely with our orthopedic colleagues to address and other joint contractures and pathology such as knee procurvatum, knee recurvatum, developmental hip conditions, and arthritic conditions.
See the video attached below that one of our patients made, try to see the before and dramatic after videos, we are so proud of her case - it makes all the long hours of study worthwhile.