Tibialis Anterior Tendon Transfer for Relapsing Idiopathic Clubfoot.

Abstract

A relapsed idiopathic clubfoot can be effectively treated with transfer of the entire tibialis anterior tendon to the mid-dorsum of the foot following repeated manipulations and serial casts. Ensure that the foot has been adequately corrected for tendon transfer by performing both clinical and radiographic evaluation. Position the patient supine, induce general anesthesia, and perform a caudal block for postoperative pain management. Identify the tibialis anterior tendon and release its insertion on the medial cuneiform and first metatarsal bones. Release obstructing tissues and prepare the freed tendon for lateral transfer to the mid-dorsum of the foot. Identify the lateral cuneiform with fluoroscopy and prepare it for transfer of the tibialis anterior tendon. Make a subcutaneous path, transfer the tendon, and secure it in the osseous tunnel of the lateral cuneiform. We apply a long leg cast and restrict patients to non-weight-bearing for six weeks. The tibialis anterior tendon transfer has been used to treat relapsing idiopathic clubfoot with great success for more than fifty years.IndicationsContraindicationsPitfalls & Challenges.