Tendon Transfers for the Balancing of Hind and Mid-foot Deformities in Adults and Children

Abstract

Tendon transfer surgery (soft-tissue balancing) is one of the most important steps for the correction of complex foot deformities in adults and children. Often, tendon transfers are accompanied by additional bony procedures for the correction of the structural component of the foot deformity. Detailed preoperative planning (patient history, clinical examination, radiographs, dynamic pedobarography, and 3D gait and foot analysis) is considered to be necessary for the indication of the technique. The surgical technique of different tendon transfers (total split posterior tibial tendon transfer, split posterior tibial tendon transfer, spilt anterior tibial tendon transfer, posterior tibial tendon transfer, Hiroshima procedure) as a part of complex foot deformity correction is presented. Furthermore, pitfalls and complications as well as salvage strategies are discussed. The key for successful soft-tissue balancing is the consideration of the underlying pathology. The main focus is on the selection of the appropriate tendon transfers in different pathologies (eg, Charcot-Marie-Tooth disease, cerebral palsy, stroke, etc.). Bony procedures may only correct structural deformity but do not address the dynamic component of the deformity (muscular imbalance, instability, etc.). This may lead to inadequate correction and recurrence. It is therefore essential to combine bony correction with tendon transfers (soft-tissue balancing) in nearly every neurogenic foot deformity.