Patient Information

Foot Drop Correction

Post Operation Instructions for Lower Limb Transfer

Days 1-3 or 4
In patient in hospital
Rest in bed or chair, leg up all the time
Commode for toileting

Day 4 / day of discharge

Trial standing and walking with boot on
Short distances only – just to prepare for moving around at home

Discharge to end of week 2
Patient at home
Leg elevated as much as possible
Down only to walk for essential activities – toilet, shower, kitchen
Review in clinic to assess wounds end of week 2

Weeks 3-6
• Boot
During the first 6 weeks, the boot is on 24/7 unless the wounds are being dressed or checked. The ankle needs to be kept at 90 degrees if the boot is off for this purpose.
• Gentle walking
If leg healing well, slowly increase walking in the boot.
The protocol now varies depending on whether the tibilalis posterior transfer is an active transfer (i.e. tibialis posterior has an MRC grade of at 4 least pre-op and we are aiming to reconstruct active dorsiflexion and eversion with this muscle) or a passive transfer (i.e. tibialis posterior is weak or paralysed.


For an Active Transfer

Weeks 6-8
Boot: Off for therapy only
Learn to activate transfer
Lie with knees flexed and hips flexed and abducted – frog-leg position
Attempt to invert both feet – transferred leg will dorsiflex
Get patient to watch and feel this action
Then sit with legs hanging over the bed and dorsiflex and plantarflex both ankles
The patient may need to think about inverting to get this action right
Gentle walking
Practise walking activate dorsiflexion with every step
Can try walking backwards and forwards with straight knees to encourage dorsiflexionUse walking aids if needed – e.g. 4-point stick, frame etc.Restrictions: No specific passive or active ankle movement or strengthening (only walking)

Weeks 8 -10
Boot: Off for therapy and boot off to practising walking at home
Gentle walking
Practise walking activate dorsiflexion with every step only at home in a safe environmentRestrictions: No specific passive or active ankle movement or strengthening (only walking)

Weeks 10-12
Boot: Wean boot – keep n at night and when at risk for falling e.g. out on public transport, at work
Gentle walking
Practise walking with the boot off and activate dorsiflexion with every step, wear secure foot wear
Restrictions: No specific passive or active ankle movement or strengthening (only walking)

Week 12
Boot: Off completely
Walking: Increase efficiency and speed
Strength: Strengthen ankle movement in all directions
Restrictions: Avoid passive plantarflexion (ongoing), other passive ranging or gentle stretching is fine but not usually needed.


For a Passive Transfer

Weeks 6-12
Boot: Boot on 24/7 unless off to check wound
Walking: Walking as much as tolerated and as much they need to do daily activities (boot on)

Week 12
Boot: Off completely, can wean over a couple of weeks if the patient feels more secure
Walking: Increase efficiency and speed with the boot off
Strength: Strengthen ankle movement in all directions
Restrictions: Avoid passive plantarflexion (ongoing), other passive ranging or gentle stretching is fine but not usually needed