DROPFOOT in MIAMI

(sometimes also called FootDrop)

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.

We focus on a specific surgical technique known as the 'tendon transfer.' This technique is among the most effective and reliable methods for addressing dropfoot, yet it is increasingly overlooked in medical education, becoming a dwindling skill among new physicians. The procedure involves relocating a tendon and muscle that serve one purpose to a different location, allowing it to fulfill a new function; in the case of dropfoot, the relocated muscle must be able to lift the ankle (raise the toes towards the shin).

Important note - not every perceived dropfoot is necessarily a dropfoot, we see many cases where a weakness of a muscle and a tightening of other muscle restricts motion and this condition which might look like a dropfoot can be corrected with even a simpler surgical solution.

In the last decade, Dr. Gitlin has relocated every muscle in the lower leg and ankle to address this issue. Why 'every muscle'? Because each case is distinct; based on the underlying cause of dropfoot, various muscles may be damaged and not functioning, making it necessary to utilize different muscles and tendons. If you investigate online, you will likely discover that the posterior tibial tendon transfer is the most frequently performed procedure, but often other tendons also require either lengthening or repositioning simultaneously. Each patient undergoes a meticulous evaluation to determine which muscles, if any, are functional and movable, as well as the optimal locations for them to be relocated for the best result.

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 2023.

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.

Factors contributing to this condition include neurodegenerative diseases affecting the brain that lead to muscular issues, such as multiple sclerosis, stroke, and cerebral palsy; motor neuron diseases like polio, certain types of spinal muscular atrophy, and amyotrophic lateral sclerosis (often referred to as Lou Gehrig’s disease); damage to the nerve roots due to conditions like spinal stenosis; peripheral nerve disorders including Charcot-Marie-Tooth disease or acquired peripheral neuropathy; localized compression or injury to the peroneal nerve as it traverses the fibular bone beneath the knee; and muscular disorders such as muscular dystrophy or myositis.

In our clinic, we employ the latest invasive and conservative methods for correcting dropfoot. To date, we have executed various combinations of tendon transfers, joint fusions, and bone osteotomies to enable patients to walk as normally as possible. Most of the time, after surgery, it’s difficult for anyone to notice that the patient ever experienced a dropfoot condition. We also recognize that surgery may not be suitable for everyone, so we incorporate nerve stimulation, physical therapy, and bracing to manage dropfoot. We collaborate closely with our orthopedic colleagues to address additional joint contractures and issues such as knee procurvatum, knee recurvatum, developmental hip problems, 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.