Is Tibialis Anterior Tendon Transfer Effective for Recurrent Clubfoot?

Abstract

Background Tibialis anterior tendon transfer surgery forms a part of Ponseti management for children with congenital talipes equinovarus who, after initial correction, present with residual dynamic supination. Although retrospective studies support good outcomes, prospective longitudinal studies in this population are lacking. Questions/purposes We assessed strength, plantar loading, ROM, foot alignment, function, satisfaction, and quality of life in patients with clubfoot that recurred after Ponseti casting who met indications for tibialis anterior tendon transfer surgery, and compared them with a group of patients with clubfoot treated with casting but whose deformity did not recur (therefore who were not indicated for tibialis anterior tendon transfer surgery).Methods Twenty children with idiopathic congenital talipes equinovarus indicated for tibialis anterior tendon transfer surgery were recruited. Assessment at baseline (before surgery), and 3, 6, and 12 months (after surgery) included strength (hand-held dynamometry), plantar loading (capacitance transducer matrix platform), ROM (Dimeglio scale), foot alignment (Foot Posture Index Ó ), function and satisfaction (disease-specific instrument for clubfoot), and quality of life (Infant Toddler Quality of Life Questionnaire TM ). Outcomes were compared with those of 12 age-matched children with congenital talipes equinovarus not indicated for tibialis anterior tendon transfer surgery. Followup was 100% in the control group and 95% (19 of 20) in the tibialis anterior transfer group. Results At baseline, the tibialis anterior tendon transfer group had a significantly worse eversion-to-inversion strength ratio, plantar loading, ROM, foot alignment, and function and satisfaction. At 3 months after surgery, eversion-to-inversion strength, plantar loading, and function and satisfaction were no longer different between groups. Improvements were maintained at 12 months after surgery (eversion-to-inversion strength mean difference, 8% body weight; 95% CI, À26% to 11%; p = 0.412; plantar loading, p [ 0.251; function and satisfaction, p = 0.076). ROM remained less and foot alignment more supinated in the tibialis anterior tendon transfer group between baseline and followup (p \ 0.001, p \ 0.001). Conclusions Tibialis anterior tendon transfer surgery was an effective procedure, which at 12-month followup restored the balance of eversion-to-inversion strength and resulted in plantar loading and function and satisfaction outcomes similar to those of age-matched children with congenital talipes equinovarus who after Ponseti casting were not indicated for tibialis anterior tendon transfer.

What is new in idiopathic clubfoot?

“…No patient in this group required subsequent surgical intervention for their clubfoot [38•]. These findings are further supported by other recent studies that demonstrate TATT improves pressure distribution through the foot during gait [39] and restores foot eversion strength [40]. While the data demonstrate TATT is a highly effective tool for preventing relapse of clubfoot, new literature suggests that a second recurrence after TATT can occur in as many as 20 % of patients [41].…”

The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy: results and factors associated with a failed outcome

“…It has been shown that re-routing the lateral half of the AT tendon onto the long axis of the fourth metatarsal was the most effective way [5,21] of correcting the deformity and is confirmed by the authors' clinical experiences. However, others have reported successful results by anchoring the AT tendon to the lateral cuneiform to coincide with the third metatarsal [22,23]. In addition, a single dorsoplantar direction tunnel with tie-over sutures was also found to be clinically effective.…”

Doğuştan çarpık ayakta alçılama sonrası aşilotomi ve tendon transferleri

“…[11] Bununla uyumlu olarak, başlangıçtaki alçılama öncesinde deformitesi daha sert olan, sınıflandırma sistemlerine göre deformite puanı daha yüksek olan ayaklarda, sonradan nüks gelişme oranı gibi, ATG oranları da daha yüksek olarak bulunmuştur. [12] …”

“…[12] Böyle bir ayak, supinasyon deformitesinin sonucunda, yürüyüş sırasında yerle daha az temas eder. Gray ve arkadaşları, [12] temas alanının azlığına karşın arka ayağın ve ayağın lateral kısmının temas süresinin uzadığını bulmuşlardır. Dinamik inversiyon deformitesi, ayağın fonksiyonlarını etkilemek yanında ayakkabı uyumunu da zorlaştırır.…”