Anterior tibial transfer to the os calcis with Achilles tenodesis for calcaneal deformity in myelomeningocele.

Abstract

Seven children aged 3.0 to 5.8 years underwent bilateral simultaneous transfer of the anterior tibial muscle to the os calcis combined with Achilles tenodesis. All patients underwent pre- and postoperative gait analysis. Results indicated decreased knee flexion in stance and decreased ankle dorsiflexion in stance resulting in a more upright posture in all patients. Electromyography revealed prolongation of firing time in both stance and swing phase of the gait cycle. Polypropylene ankle-foot orthoses, used to protect the transfers in the postoperative period, improved step length, single limb support, and walking velocity in all patients. Three patients underwent force plate analysis to calculate work output. The reduction in work from 1.578 to 0.628 joules/kg/m suggested a favorable reduction in the work required to ambulate following surgery. No equinus deformity developed as a consequence of the Achilles tenodesis. These preliminary findings suggest the combined procedure restored a more optimal balance to the foot and ankle. Postoperative orthotic support was beneficial for protection of the corrected alignment as well as long-term function.