Tibialis Posterior Tendon Transferi Uygulanmış Hastalarda Geç Dönem Fizyoterapi Uygulamalarının Sonuçları

Abstract

This study was planned to determine the efficacy of late-period physiotherapy for late-period biomechanical problems in foot-drop patients who underwent tibialis posterior tendon transfer after peripheral nerve injury. Patients who were operated at the Department of Plastic and Reconstructive Surgery, İstanbul Faculty of Medicine, İstanbul University, and followed up at least 6 months, were included to the study. All patients had tendon transfer due to foot-drop. Medical history of patients, demographic data and complications were recorded. Pain, functional status due to pain, and muscle force were measured by visual analogue scale, Foot Function Index, handheld dynamometer, respectively. Ankle range-of-motion was evaluated by universal goniometer, whereas foot posture was evaluated by navicular height, metatarsal width, subtalar angle, first metatarsophalangeal joint angle measurements. All measurements were performed bilaterally for weight/weight-free conditions. In order to determine functional recovery and post-surgery success, Stanmore System Questionnaire was used. Gait parameters of the cases were obtained by pedobarographic analysis in static and dynamic states. In addition, sensory evaluation, sense of joint position, balance, and quality of life were recorded. Patient-specific physiotherapy programs based on the needs generally included heat modalities, neuromuscular electrical stimulation, exercise, taping, and orthoses. Treatments were continued for 6 weeks, 3 days a week. All pre-treatment evaluations were repeated in the 4th and 6th weeks and at the end of 3rd month to determine the effects of treatment. During the study, pain and activity limitation were reduced by the 4th week on VAS and AFI. Patients were socially more active by the 6th week of treatment and their isolation was reduced and their social activity reached maximal level at the 12th week (p<0.05). Late-period physiotherapy program in our study resulted in muscle strength increase in ankle muscles of both affected and intact sides (p<0.05). Increase in contact area of foot led to sensory improvement (p<0.05). At the end of study, functional status, dorsiflexion and eversion muscle strength were increased. Dorsiflexion range of motion and Stanmore score increased. Sensation, proprioception, and balance improved (p<0.05 for all). In addition, quality-of-life and pedobarographic improvements were found (p<0.05).