Modified bridle versus bridle tendon transfer procedures for the treatment of foot drop.

Abstract

Objective: Foot drop results in considerable disability for the patient. We transferred tibialis posterior tendon in a modification of Bridle procedure in such patients and recorded the pre-operative and post-operative data. Then we compared them with standard Bridle procedure to ascertain the comparative efficacy. Study Design: Quasi-experimental study. Setting: Jinnah Burn and Reconstructive Centre (JBRSC) Lahore. Period: 1^st October 2024 to 30^th April 2025. Methods: On a total of 70 patients after consent, the patients were divided into two groups: Group A had Modified Bridle procedure as tendon of tibialis posterior (TP) was anastomosed to the extensor hallucis longus as well as extensor digitorum longus above the retinaculum and a slip was Pulvertaft to tibialis anterior below the retinaculum. Group B underwent standard Bridle procedure. Patient satisfaction, dorsiflexion and hammer toe deformity were assessed after which analysis was done using Statistical Package of Social Sciences (SPSS) version 25. P-value less than 0.05 was considered statistically significant. Results: Both groups were comparable at baseline (age, sex, side, cause of foot drop, hammer-toe), supporting a fair outcome comparison. The modified Bridle showed a clear shift toward better dorsiflexion grades (Excellent/Good 85.7% vs 60.0%), with the overall test narrowly missing significance (p-value=0.051), suggesting a strong favorable trend. Patient satisfaction was higher with the modified procedure (85.7% vs 57.1%; p-value=0.042). Overall, results indicate that the modified Bridle yields better patient-reported outcomes, with a near-significant advantage in functional dorsiflexion. Conclusion: This modification of Bridle procedure improves the outcome of patients with foot drop helping them in this severely debilitating disease in terms of improved dorsiflexion, better patient satisfaction and very few chances of hammer-toe deformity in comparison to standard Bridle procedure.