Tibialis Anterior Tendon Transfer after Clubfoot Surgery

Abstract

Recurrent dynamic and structural deformities following clubfoot surgery are commonly due to residual muscle imbalance from a strong tibialis anterior muscle and weak antagonists. We asked whether subcutaneous tibialis anterior tendon transfer effectively treated recurrent deformities following clubfoot surgery and whether the presence of structural deformities influenced the outcome. The patients were divided into two groups: Group I, dynamic supination deformity only (51 patients, 76 feet); and Group II, dynamic supination with other structural deformities (44 patients, 61 feet). The mean age at surgery was 4.3 years (range, 1.4-10.7 years); the minimum followup was 2 years (mean, 5.2 years; range, 2-12.5 years) for both groups. The results were graded according to our subjective rating system of restoration of muscle balance: good, restoration of muscle balance; fair, partial restoration of muscle balance; and poor, no improvement. The two groups had similar outcomes: in Group I, there were 65 good (87%), 11 fair (13%), and no poor results and in Group II, there were 54 good (88%), seven fair (12%), and no poor results. Our data suggest the tibialis anterior tendon transfer restores muscle balance in recurrent clubfeet; we observed no recurrences. This transfer improves function and may prevent secondary osseous changes. We believe the muscle imbalance supports, at least in part, the neuromuscular etiological aspects of congenital clubfeet.

Is Tibialis Anterior Tendon Transfer Effective for Recurrent Clubfoot?

“…To minimize these effects, but without compromising gains in ROM, casts were removed at least 1 week before baseline assessment. Consistent with our findings, improvements of eversion strength after tibialis anterior tendon transfer surgery have been reported, however this has not been documented after Ponseti treatment [6,12,23]. In a retrospective review of 55 patients (71 congenital talipes equinovarus feet), Kuo et al [12] noted an improvement of eversion strength of 1.5 grades according to the Jones classification at an average of 8.8 years after tibialis anterior tendon transfer surgery.…”

“…The current evidence base for tibialis anterior tendon transfer includes a cadaveric biomechanical study [9], retrospective chart reviews [14,23], a cross-sectional trial [6], or cohorts who had previous surgery [12]. However, prospective evidence of efficacy is lacking.…”

“…In a retrospective review of 55 patients (71 congenital talipes equinovarus feet), Kuo et al [12] noted an improvement of eversion strength of 1.5 grades according to the Jones classification at an average of 8.8 years after tibialis anterior tendon transfer surgery. Thompson et al [23] reviewed muscle balance after tibialis anterior tendon transfer surgery using an independent assessment that graded postoperative muscle balance as good (full restoration), fair (partial restoration), or poor (no improvement). At 4.3 years after tibialis anterior tendon transfer surgery, they found 87% had good results, 13% had fair results, and 0% had poor results.…”

“…All surgical procedures were performed by two surgeons (MB, PG) at the same hospital using a technique similar to that described by Thompson et al [23]. In all but one foot, the tibialis anterior tendon was wholly transferred to the lateral cuneiform, attached via a whipstitch suture passed through a drill hole and sutured over a sponge and button in the sole of the foot.…”

“…Although long-term retrospective data have shown good outcomes after tibialis anterior tendon transfer surgery, the majority of trials include patients who have undergone various treatments, including serial plaster casting, and soft tissue and bony surgical procedures [6,10,13,23]. Furthermore, it is unknown whether improvements after tibialis anterior tendon transfer surgery result in outcomes comparable to those of children with congenital talipes equinovarus who do not require this surgery.…”