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Is Tibialis Anterior Tendon Transfer Effective for Recurrent Clubfoot?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

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©), function and satisfaction (disease-specific instrument for clubfoot), and quality of life (Infant Toddler Quality of Life Questionnaire™). 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, −26% 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.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia

    Kelly Gray B App Sc (Physiotherapy), Joshua Burns PhD, David Little MBBS, FRACS(Orth), PhD, Michael Bellemore MBBS, FRACS & Paul Gibbons MBBS, FRCS(Orth), FRACS

  2. The University of Sydney, Sydney, NSW, Australia

    Kelly Gray B App Sc (Physiotherapy), Joshua Burns PhD, David Little MBBS, FRACS(Orth), PhD, Michael Bellemore MBBS, FRACS & Paul Gibbons MBBS, FRCS(Orth), FRACS

Authors
  1. Kelly Gray B App Sc (Physiotherapy)
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  2. Joshua Burns PhD
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  3. David Little MBBS, FRACS(Orth), PhD
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  4. Michael Bellemore MBBS, FRACS
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  5. Paul Gibbons MBBS, FRCS(Orth), FRACS
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Corresponding author

Correspondence to Kelly Gray B App Sc (Physiotherapy).

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This study was performed at The Children’s Hospital at Westmead, Westmead, Australia.

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Gray, K., Burns, J., Little, D. et al. Is Tibialis Anterior Tendon Transfer Effective for Recurrent Clubfoot?. Clin Orthop Relat Res 472, 750–758 (2014). https://doi.org/10.1007/s11999-013-3287-x

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  • DOI: https://doi.org/10.1007/s11999-013-3287-x

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