Operative treatment of the plantar-flexed inverted foot in adult hemiplegia

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Tracy-HW J-Bone-Joint-Surg-Am. 1976 Dec; 58(8): 1142-5 From a population of 902 adult patients with acquired hemiplegia, thirty-two patients with extensor synergy were chosen for a reconstructive procedure designed to eliminate the need for an orthosis. Three additional patients underwent the procedure to eliminate severe spasticity which precluded orthotic fitting. The operative technique, first described by Mooney and associates, involved lengthening of the tendo achillis and tibialis posterior tendon, multiple toe-flexor tenotomies, and a split transfer of the tibialis anterior tendon. Satisfactory results were recorded for thirty-two patients. The three failures were ascribed to inappropriate selection of patients for surgery.