1142 THE JOURNAL OF BONE AND JOINT SURGERY Operative Treatment of the Plantar-Flexed Inverted Foot in Adult Hemiplegia*

ABSTRACT: From a population of 902 adult patients with acquired hemiplegia, thirty-two patients with ex-tensor synergy were chosen for a reconstructive proce-dure 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. Acquired hemiplegia in the adult, whether the result of intracranial injury or of disease, produces typica