CME OnDemand: 2022 AOFAS Annual Meeting-Proximal Flexor Hallucis Longus Transfer to Peroneus Brevis for Treatment of Peroneal Muscle Paralysis

Pdf Summary

This document presents a case report on the use of proximal flexor hallucis longus (FHL) transfer to peroneus brevis (PB) for the treatment of peroneal muscle paralysis. The patient in the case report is a 22-year-old female who had bilateral equinovarus deformities due to a spinal cord injury and traumatic brain injury. The physical examination showed intrinsic muscle spasticity and no active peroneal tendon function.<br /><br />The plan for treatment included Achilles lengthening, FHL and flexor digitorum longus (FDL) release, and proximal FHL to PB transfer. The operative technique involved a medial midfoot approach for FHL tendon tenotomy and a posterolateral ankle approach to identify and deliver the FHL tendon to the posterolateral wound. The FHL was then tenodesed to PB using a Pulvertaft weave.<br /><br />The post-operative course included weight-bearing as tolerated in a short leg cast for 10 weeks. At the 4-month follow-up, the patient was able to walk with an ankle-foot orthosis (AFO) but still required Botox injections for intrinsic muscle spasticity. The deformity correction was maintained.<br /><br />The document also mentions that this procedure has advantages such as decreased comorbidities and the ability to be performed through a posterolateral approach only. However, it emphasizes that the PB must be intact for the procedure to be successful. The Pulvertaft weave tenodesis is recommended for the transfer.<br /><br />In summary, this case report highlights the use of proximal FHL transfer to PB as a treatment option for peroneal muscle paralysis. The procedure showed successful deformity correction and improved functionality in the patient. Further research is needed to evaluate the long-term outcomes and effectiveness of this technique.

Asset Subtitle

Alex M. Moses, MD, Moawiah Mustafa, Edward T. Haupt, MD

Keywords

proximal flexor hallucis longus transfer

peroneus brevis

peroneal muscle paralysis

equinovarus deformities

spinal cord injury

traumatic brain injury

Achilles lengthening

flexor digitorum longus release

Pulvertaft weave tenodesis

ankle-foot orthosis