Split Tibialis Anterior Transfer for Correction of Residual Dynamic Metatarsus Adductus Following Ponseti Management of Idiopathic Clubfoot

Abstract

Background: Clubfoot represents one of the most common congenital orthopedic deformities. It affects 1-2/1000 live births all over the world. Cases of dynamic and severe deformity represent a challenging problem. This is because the conservative management is not effective as well as the surgical options are little. Objective: Aim of the present study was to evaluate the better management of split tibialis anterior tendon transfer in the treatment of residual clubfoot. Patients and methods: Eighteen cases (22 feet) with residual dynamic supination deformity following previous Ponseti management underwent split transfer of the anterior tibial tendon. This was a prospective study between March 2020 and February 2021, the cases were collected and the study was carried out at Zagazig University Hospitals. Results: In our study, the mean age was 41.05 months (ranged from 30 to 59 months). Out of the 18 patients, there were 12 males and 6 females. Four cases (22.2%) were bilaterally affected. While 14 patients (77.8%) were one-side affected (5 left foot affected and 9 right foot affected). Our results showed marked improvement of patients according to Garceau and Palmer's criteria as the mean pre-operative assessment was 2.5 reaching 3.28 post-operatively. 14 patients (88.9%) were either poor or fair and no single patient was excellent pre-operatively, while postoperatively all patients became either excellent mostly or good. Conclusion:Anterior tibial tendon transfer is a reasonable method of achieving the objective, either fully or split transfer because both operations have excellent results with low rate of major complications. It's very simple but yet very effective soft-tissue procedure to correct the muscle imbalance of the foot.