Comparison of the Ponseti method versus early tibialis anterior tendon transfer for idiopathic clubfoot: A prospective randomized study

Abstract

ObjectiveThe aim of the study was to compare functional and radiological outcomes in clubfoot patients treated by early Tibialis anterior tendon transfer and Ponseti method. Materials and methodsA prospective, randomized study was conducted. A total of 39 children with a mean age of 17.05 days (55 clubfeet) were randomly allocated into one of two groups: first (conservative Ponseti method) group (n=28) or second (early tibialis anterior tendon transfer [TATT]) group (n=27). Foot function and radiographic measurements were evaluated. The condition of the subjects was observed until they reached the age of 2 years. ResultsThe clinical and radiological data did not differ between groups at the age of 6 months. No statistically significant difference regarding Pirani and Dimeglio scale among the groups was observed at the last follow-up. A statistically significant difference was observed in the foot dorsal flexion; it was lower in the second group (P=0.03). Other clinical parameters did not differ between groups. According radiographic data, only the talocalcaneal angle (TCA) was significantly higher in the second group (P=0.003). Children who underwent TATT were 5.00-fold (P=0.002) and 1.67-fold (P=0.017) more likely to have TCA larger than 30° (which reflects the normal range of the TCA) in DP and lateral views, respectively, and 3.40-fold (P=0.019) more likely to have foot dorsal flexion of less than 15° than their counterparts undergoing the conservative Ponseti treatment. ConclusionsEarly TATT allowed a significant reduction in the brace wear duration and resulted in the same outcomes as using the Ponseti method. Additionally, TATT can provide some improvement of hindfoot varus. However, a possible weakening of dorsiflexion should be also taken into account. Our experience has shown the need for a larger sample and longer term studies.