Split transfer of tibialis anterior for equinovarus foot deformity in cerebral palsy

Abstract

: Foot deformities in children with cerebral palsy are common. The various foot deformities are equinus, planovalgus, equinovarus, equinovalgus. Treatment for the flexible foot deformity should be with orthotics and manual therapy initially and then with tendon lengthening. Equinovarus deformity of the foot is a result of the muscle imbalance in which invertors of the foot, posterior and anterior tibialis muscle, overpower evertors. Untreated spastic equinovarus deformity may cause severe fixed foot deformity and painful callosities under metatarsal heads and on the lateral side of foot. To evaluate the effectiveness of split transfer of tibialis anterior for equinovarus foot deformity in spastic cerebral palsy children.40 spastic cerebral palsy (13 diplegic and 27 hemiplegic) children between the age of 5-15 years with equinovarus foot deformity were selected. The procedure adopted in all the cases was tendoachilles lengthening and split anterior tibialis tendon transfer to cuboid. The result was graded as good, fair and poor. In 28 of the cases varus deformity of the forefoot and midfoot got corrected with plantigrade foot, in 10 of the cases forefoot and midfoot supination was corrected but heel was in varus and in 2 of the cases there was no improvement.: Spastic T.A. is most often the cause of varus of forefoot. Split transfer utilises the spastic nature of the muscle to counter balance the deformity caused by the original muscle. Hence, it is better solution to the problem. However accurate diagnosis of deforming muscle, i.e, T.A or T.P. is essential to produce good result.