the necessity of osteotomy or arthrodesis. It is necessary to determine whether the deformity of the foot is fixed or flexible, as this may have implications for the use of only tendon transfers vs. Sensory loss to the bottom of the foot in conjunction with a power score of less than 4/5 for the PTT may imply a concomitant tibial nerve injury. the contralateral side are important examination maneuvers to rule out PTT insufficiency. Weakness of inversion, plantarflexion, forefoot abduction, forefoot varus, hindfoot valgus, and a loss of the medial arch vs. The presence of a fully functioning posterior tibial tendon (PTT) impacts treatment options. A fluoroscopic image demonstrates the Keith needle has been drilled through the middle cuneiform. A clinical photograph shows the anastomosis is sutured and the Keith needle has been drilled into the middle cuneiform.6. The same incision was able to be used for fracture fixation.5. The peroneus longus has been harvested and tenodesed proximally to the brevis.
The PTT is passed through the AT in the anterior compartment.4. The PTT has been passed through the intraosseous membrane to the anterior compartment and the tendon has been retrieved with excellent length for tendon transfer completion to the dorsum of the foot.3. The Metzenbaum scissors are beneath the AT. The surgeon’s finger is in the second incision where the PTT is retrieved. Anteroposterior (AP) and lateral images of the left ankle demonstrate the bimalleolar ankle fracture.2. Of note, secondary to the patient’s clinical exam and the chronicity of the penetrating trauma, electrodiagnostic studies were deferred. Additional workup for infection was negative, and laboratory values including a complete blood count, basic metabolic panel and prothrombin time/international normalized ratio were within normal limits. The clinical exam is consistent with a foot drop secondary to penetrating trauma to the common peroneal nerve. Plain films revealed a bimalleolar ankle fracture to the left lower extremity (Figure 1). Bimalleolar ankle fracture to the left lower extremity Ligamentous stability, heel rise and special testing about the ankle were also deferred due to the significant pain and swelling. The patient was unable to bear weight on the affected extremity, and thus ambulation was not tested. Sensation was intact to the saphenous and sural nerves, while absent from the deep and superficial peroneal nerve distributions. His foot was resting in neutral position and unable to be passively or actively dorsiflexed past 0°. Examination was notable for mild swelling about the ankle with a supple foot, as well as two well-healed scars about the anterior and posterolateral leg just distal to the knee consistent with a history of ballistic insult.
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