Correction of Residual Metatarsus Adductus Deformity Following Ponseti Management of Idiopathic Clubfoot in Toddlers by Tibialis Anterior Tendon Transfer

Abstract

Background: Ponseti technique becomes a gold standard treatment for correction of idiopathic clubfoot and widely reports to provide reliable results. However, a relapsed deformity may occur owing to imbalance of strong tibialis anterior and weak its antagonist resulting in dynamic metatarsus adductus deformity of forefoot. Purpose of study: The aim of this study is reporting the results of our experience regarding tibialis anterior tendon transfer for correction of previous deformity. Patients and methods: In this prospective case series study, 21 children (9 females) with residual dynamic metatarsus adductus following treatment of idiopathic congenital talipes equinovarus utilizing Ponseti technique in the orthopedic department of Al-Azher University Hospital, Mapera Zagazig Hospital and El-Bakry General Hospital treated by transfer of tibialis anterior tendon into third cuneiform bone. Evaluation comprised clinical, appearance, radiological assesment and complications. Results: Mean follow-up 23.4 months and mean age of patients 35.3 months. All transferred tendons healed properly without major complications. Clinically; Dimeglio score improved from 5.8 preoperative to 1.3 postoperative and the clinical appearance according to Garceau and Palmer improved from 2.8 to 3.4. No major complications or correction loss developed in any case. Conclusion: Residual dynamic metatarsus adductus deformity following Ponseti management of congenital talipes equinovarus can be corrected efficiently and simply by tibialis anterior tendon transfer.