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New cutting-edge surgery provides relief for people with foot drop

Houston, TX - 6/1/2010

A new surgery that involves an expendable, functioning muscle from the top of the leg and a nerve below the knee can give people with foot drop a new bounce in their step.

"Foot drop is a condition where there is weakness in the muscles that raise the foot up at the ankle," said Dr. Kevin Varner, an orthopedic surgeon with The Methodist Hospital in Houston. "People with foot drop are unable to clear their foot from the ground when swinging the foot forward. This condition is often very embarrassing and is usually caused by trauma such as a knee dislocation or penetrating injury that damages the nerve."

People with foot drop can wear a brace that help pick their foot up, but it is often cumbersome. Another treatment is a tendon transfer, which involves moving the tendon from the back of the leg to the front and re-routing tendon function. The problem is the tendon is used to push the foot down, so people have to re-learn how to pull their foot up. This new procedure is called a functional muscle transfer is an alternative to both therapies. It’s a complex operation that involves the gracilis muscle and the peroneal nerve.

"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," said Dr. Michael Klebuc, a plastic surgeon with The Methodist Hospital Institute for Reconstructive Surgery in Houston. "If all goes well, in about six months, the peroneal nerve fibers will grow into the transplanted muscle and people will be able to lift their foot up and walk without a brace."

The gracilis muscle is not a critical muscle in the leg. There are other muscles that are responsible for bringing the knees together, so you can take this one out and continue to live a normal life. This surgery only works for injuries below the knee.

"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."

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