From a population of 902 adult patients with acquired hemiplegia,
thirty-two patients with extensor synergy were chosen for a reconstructive
procedure 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.