Surgical prevention of foot deformity in patients with Duchenne muscular dystrophy

The purpose of this study was to evaluate the results of a modification of the posterior tibial tendon transfer in Duchenne muscular dystrophy patients with regard to foot deformity and ambulation. The records of 57 patients with Duchenne muscular dystrophy were retrospectively reviewed. Three treatment groups were studied: group 1, those who had surgery to maintain ambulation; group 2, those who had surgery to correct and maintain foot position; and group 3, those who had no surgery. All surgical patients had posterior tibial tendon transfer and Achilles tendon lengthening as part of their procedure. Thirty-four patients returned for interviews and examinations to assess outcomes and foot position. The mean age at cessation of ambulation for those who had surgery was 11.2 years versus 10.3 years for those who did not have surgery. Of 48 feet in 24 patients who underwent lower extremity surgery to correct and maintain foot position, 94% were clinically satisfactory at a mean of 8.5 years after surgery. Regardless of the desire to continue ambulation, all patients should have posterior tibial tendon transfer, Achilles tendon lengthening, and toe flexor tenotomies to maintain plantigrade feet.