Foot Drop / Partial Paralysis After Stroke

47 year old female with history of stroke/CVA due to hemorrhage at age 21. Has lived with partial paralysis to the left side of her body since then, including foot drop and equinovarus deformity to her lower extremity. She had subsequent brain surgery, and has a plate in her skull. She has been in physical therapy off and on for many years. She wore an AFO (ankle foot orthosis) that was tattered when I first met her 5 months ago. She was referred to our clinic by her physical therapist. Her Achilles tendon was so tight she was no longer fitting in her AFO brace, and PT felt they were in a losing battle. She was understandably frustrated. She is an extremely independent person, and has managed to be functional despite her partial paralysis. When I told her I thought we could help she was in tears as she had been told by a few clinicians over the years nothing could be done aside from her leg brace, which was now causing pressure lesions/sores…

On exam, would call eversion/dorsiflexion strength 40-50% of normal.

Our surgical plan was:

Percutaneous TAL with beaver blade
Triple Arthrodesis
Peroneus longus to Brevis tendon transfer
Partial PT tendon release
Excision of adventitious bursa that formed near chronic 5th met fracture site

We did take the time to explain this may not be her last surgery, but felt it would be the “workhorse” of what she needed.
Post-op films you’ll notice some 1st ray elevatus.

She did give us permission to use her videos in a public forum.
She is wearing a sneaker for the 1st time without a brace (to our dismay) in 20+ years.