Tibialis Posterior Tendon Transferi Uygulanmış Olan Düşük Ayak Hastalarında Geç Dönem Fizyoterapi Uygulamalarının Sonuçları

Yıl 2021, , 115 - 123, 10.09.2021

Safiye Özkan , Nilgün Bek , Türker Özkan , Ömer Berköz

https://doi.org/10.15437/jetr.711328

Öz

Amaç: Bu çalışma periferik sinir yaralanması sonrasında düşük ayak gelişmiş bireylerde uygulanan tibialis posterior tendon transferlerinde, geç dönemde meydana gelen biyomekanik sorunlar ve bu sorunların tedavisi için uygulanan, geç dönem fizyoterapinin etkinliğini belirlemek amacıyla planlandı.

Yöntem: Çalışmaya tendon transferi yapılmış ve 6 ay ve üzeri süreyi doldurmuş olan 22 birey dahil edildi. Bireylerle ilgili demografik bilgi ve komplikasyonlar kayıt edilerek, ayak bileği kas kuvveti, eklem hareket açıklığı ölçüldü. Ayrıca bireylerde eklem pozisyon hissi, denge ve yaşam kalitesi değerlendirildi. Cerrahi sonrası başarı için Stanmore Sistem Sorgulaması kullanıldı. Olgulara genel olarak, ısı modaliteleri, nöromuskuler elektrik stimülasyonu, egzersiz, bantlama ve ortezlemeyi içeren, bireylerin spesifik gereksinimleri gözetilerek planlanan fizyoterapi programı uygulandı. Tedavilere 6 hafta süreyle haftada 3 gün olmak üzere devam edildi. Tedavi öncesi yapılan değerlendirmeler, 4., 6. haftalarda ve 3 ayda tekrar edildi.

Bulgular: Çalışma süresi içerisinde bireylerin ayak bileği kas kuvveti, her iki ayakta da arttı. Bunlara ek olarak, propriyosepsiyon ve dengede olumlu gelişmeler meydana geldi. Tüm bu gelişmeler sayesinde, olguların yaşam kalitesi de pozitif yönde etkilendi.

Sonuç: Çalışma sonucunda, tendon transferi sonrası geç dönemde uygulanan fizyoterapi programının, geç dönemde olgularda görülen problemler üzerinde etkin olduğu gösterildi. Detaylı değerlendirme ile planlanan fizyoterapi programının, hasta memnuniyetini ve cerrahi başarıyı arttırdığı belirlendi.

Anahtar Kelimeler

Düşük ayak, Tendon transferi, Tibialis posterior, Rehabilitasyon, Yaşam kalitesi

Results of late-period physical therapy practice in foot-drop patients who underwent tibialis posterior tendon transfer

Öz

Purpose: 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.

Methods: Twenty-two patients who were operated and followed up at least 6 months were included to the study. Demographic data and complications about patients were recorded and muscle force and ankle range-of-motion were evaluated. In addition, sense of joint position, balance, and quality of life were evaluated. In order to determine post-surgery success, Stanmore System Questionnaire was used. A physiotherapy program specifically based on individual patients’ needs included heat modalities, neuromuscular electrical stimulation, exercise, taping, and orthoses. Treatments were carried out 3 days a week, for the duration of 6 weeks. 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.

Results: During the study, muscle strength increased in ankle muscles of both affected and intact sides. In addition, proprioception, and balance improved. Quality-of-life was affected positively related with these changes.

Conclusion: This study has revealed that late-period physical therapy practice in foot-drop patients who underwent tibialis posterior tendon transfer was effective on the late-period problems of the patients. This study has determined that the physiotherapy programs that are planned with detailed evaluation will improve patient satisfaction and surgical success.

Anahtar Kelimeler

Foot drop, Tendon transfer, Tibialis posterior, Rehabilitation, Quality of life.

Kaynakça

• 1. Steinau HU, Tofaute A, Huellmann K, Goertz O, Lehnhardt M. et al. Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements. Arch Orthop Trau Surg. 2011;131(7): 903-910.
• 2. Irgit, KS, Cush G. Tendon transfers for peroneal nerve injuries in the multiple ligament injured knee. The Journal of Knee Surgery. 2012; 25: 327–334.
• 3. Ozkan T, Tuncer S, Ozturk K, Aydın A, Ozkan S. Surgical restoration of drop foot deformity with tibialis posterior tendon transfer. Acta Orthopaedica et Traumatologica Turcica. 2007; 41(4) : 259-265.
• 4. Schweitzer K.M, Jones CP. Tendon transfers for the drop foot. Foot and Ankle Clinics. 2014; 19: 65-71.
• 5. Zouita ABM, Majdoub O, Ferchichi H, Grandy K, Dziri C. Et al. The effect of 8-weeks proprioceptive exercise program in postural sway and isokinetic strength of ankle sprains of Tunisian athletes. Annuals of Physical and Rehabilitation Medicine. 2013;56: 634–643.
• 6. Flansbjer UB, Blom J, Brogardh C. The reproducibility of bergbalance scale and the single-leg stance in chronic stroke and the relationshipbetween the two tests. The Journal of Injury, Function and Rehabilitation. 2012; 4:165-170.
• 7. Ozkan T, Tuncer S, Ozturk K, Aydın A, Ozkan S. Tibialis posterior tendon transfer for persistent drop foot after peroneal nerve repair. Journal of Reconstructive Microsurgery. 2009; 25(3): 157-64.
• 8. Kılıç A, Parmaksızoğlu AS, Kabukçuoğlu Y, Bilgili F., Sökücü S. Extramembranous transfer of the tibialis posterior tendon for the correction of drop foot deformity. Acta Orthopaedica TraumatologicalTurcica. 2008; 42(5): 310-315.
• 9. SooHoo NF, Vyas R, Samimi D. Responsiveness of the Foot Function Index, AOFAS Clinical Rating Systems, and SF-36 after Foot andAnkle Surgery. Foot & Ankle International. 2006; 27(11): 930-934.
• 10. Jeng C, Myerson M. The Uses of Tendon Transfers to Correct Paralytic Deformity of the Foot and Ankle. Foot and Ankle Clinics. 2004; 9: 319-337.
• 11. Richardson DR, Gause LN. Bridle Procedure. Foot and Ankle Clinics.2011;16: 419-433.
• 12. Hastings M K, Sinacore D R, Woodburn J, Paxton ES, Klein SE, McCormick JJ. et al. Kinetics and kinematics after the Bridle procedure for treatment of traumatic foot drop. Clinical Biomechanics. 2013; 28:555–561.
• 13. Ninković M, Ninković M. Neuromusculotendinous transfer: an original surgical concept for the treatment of drop foot with long-term follow-up. Plastic and reconstructive surgery. 2013; 132(3): 438-445.
• 14. Srinivasan H, Mukherjee SM, Subramaniam RA. Two tailed transfer of tibialis posterior for correction of drop foot in leprosy. The Journal of Bone and Joint Surgery British Volume.1968; 50: 623-628.
• 15. Soares D. Tibialis posterior transfer for the correction of foot drop in leprosy. The Journal of Bone and Joint Surgery. 1996; 78-B(1): 61-62.
• 16. Yeap JS, Birch R, Singh D. Long-term results of tibialis posterior tendon transfer for drop foot. International Orthopaedics.2001;25: 114-118.
• 17. Shah RK. Tibialis posterior transfer by interosseous route for the correction of foot drop in leprosy. İnternational Orthopaedics.2009; 33:1637-1640.
• 18. Dover G, Powers ME. Reliability of joint position sense and force-reproduction measures during internal and external rotation of the shoulder. Journal of Athletic Training.2003; 38(4): 304–310.
• 19. Cote KP, Brunet ME, Gansneder BM, Shultz SJ. Effects of Pronated and Supinated Foot Postures on Static and Dynamic Postural Stability. Journal of Athletic Training.2005; 40(1): 41–46.
• 20. Vigasio A, Marcoccio İ, Patelli A, Mattiuzzo V, Prestini G. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clinical Orthopaedics and Related Research. 2008; 466:1454–1466.
• 21. Bekler H, Beyzadeoğlu T, Gökçe A. Düşük ayak deformitesinde posterior tibial tendon transferi. Acta Orthopaedica et Ttraumatologica Turcica. 2007; 41(5): 387-392.
• 22. Rath S, Schreuders TAR., Stam HJ, Hovius SER, Selles RW. Early Active Motion versus immobilization after tendon transfer for foot drop deformity. Clinical Orthopedics Related Research. 2010; 468:2477-2484.