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Lateral Intra-Articular Transposition of the Anterior Tibialis Tendon for the Treatment of Relapsed Clubfoot in Toddlers: A Previously Unreported Surgical Technique

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DOI: 10.4236/ojo.2014.43010    2,894 Downloads   4,446 Views   Citations

ABSTRACT

Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method for correcting this deformity when the cuneiform is ossified in children who are 3 to 5 years of age. We describe two cases of a previously unreported method of ATT transposition for correction of bilateral residual dynamic supination in a 26-month-old and a 19-month-old patient. Both patients presented shortly after birth with bilateral congenital idiopathic clubfoot and were initially treated with the Ponseti method. Both had residual deformity following initial treatment that included posterior contracture and metatarsus adductus with dynamic forefoot supination. This was surgically corrected with a posterior release and medial release of the 1st metatarsal/1st cuneiform joint. To correct dynamic supination, the ATT was transplanted laterally into the released midfoot joint. These two patients were followed post-operatively for 7.5 years and have correction of their residual deformity in both feet based on subjective functioning, appearance, range of motion, strength, and gait. Both have excellent lateral pull of their ATT, which functions as a strong foot dorsiflexor. No residual supination is present. This is the first report of lateral transposition of the ATT as an interposition graft at the released 1st metatarsal/1st cuneiform joint in patients with relapsed clubfoot. We suggest that this method should provide a high level of functioning in children with relapsed supination deformity and whose 3rd cuneiform has not yet ossified.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Opel, D. , Abrams, S. , Halanski, M. and Noonan, K. (2014) Lateral Intra-Articular Transposition of the Anterior Tibialis Tendon for the Treatment of Relapsed Clubfoot in Toddlers: A Previously Unreported Surgical Technique. Open Journal of Orthopedics, 4, 53-59. doi: 10.4236/ojo.2014.43010.

References

[1] Abdelgawad, A.A., Lehman, W.B., van Bosse, H.J., Scher, D.M. and Sala, D.A. (2007) Treatment of Idiopathic Club Foot Using the Ponseti Method: Minimum 2-Year Follow-Up. Journal of Pediatric Orthopedics. Part B, 16, 98-105.
[2] Laaveg, S.J. and Ponseti, I.V. (1980) Long-Term Results of Treatment of Congenital Club Foot. The Journal of Bone and Joint Surgery. American Volume, 62, 23-31.
[3] Ponseti, I.V. and Smoley, E.N. (2009) The Classic: Congenital Club Foot: The Results of Treatment. 1963. Clinical Orthopaedics and Related Research, 467, 1133-1145.
http://dx.doi.org/10.1007/s11999-009-0720-2
[4] Singer, M. and Fripp, A.T. (1958) Tibialis Anterior Transfer in Congenital Club Foot. The Journal of Bone and Joint Surgery. British Volume, 40, 252-255.
[5] Thompson, G.H., Hoyen, H.A. and Barthel, T. (2009) Tibialis Anterior Tendon Transfer after Clubfoot Surgery. Clinical Orthopaedics and Related Research, 467, 1306-1313.
http://dx.doi.org/10.1007/s11999-009-0757-2
[6] Farsetti, P., Caterini, R., Mancini, F., Potenza, V. and Ippolito, E. (2006) Anterior Tibial Tendon Transfer in Relapsing Congenital Clubfoot: Long-Term Follow-Up Study of Two Series Treated with a Different Protocol. Journal of Pediatric Orthopedics, 26, 83-90.
http://dx.doi.org/10.1097/01.bpo.0000188999.21427.fb
[7] Tarraf, Y.N. and Carroll, N.C. (1992) Analysis of the Components of Residual Deformity in Clubfeet Presenting for Reoperation. Journal of Pediatric Orthopedics, 12, 207-216.
http://dx.doi.org/10.1097/01241398-199203000-00011
[8] Critchley, J.E. and Taylor, R.G. (1952) Transfer of the Tibialis Anterior Tendon for Relapsed Club-Foot. The Journal of Bone and Joint Surgery. British Volume, 34, 49-52.
[9] Garceau, G.J. (1940) Anterior Tibial Tendon Transposition in Recurrent Congenital Club-Foot. The Journal of Bone & Joint Surgery, 22, 932-936.
[10] Kuo, K.N., Hennigan, S.P. and Hastings, M.E. (2001) Anterior Tibial Tendon Transfer in Residual Dynamic Clubfoot Deformity. Journal of Pediatric Orthopedics, 21, 35-41.
http://dx.doi.org/10.1097/01241398-200101000-00009
[11] Garceau, G.J. and Palmer, R.M. (1967) Transfer of the Anterior Tibial Tendon for Recurrent Club Foot. A Long-Term Follow-Up. The Journal of Bone and Joint Surgery. American Volume, 49, 207-231.
[12] Masrouha, K.Z. and Morcuende, J.A. (2012) Relapse after Tibialis Anterior Tendon Transfer in Idiopathic Clubfoot Treated by the Ponseti Method. Journal of Pediatric Orthopedics, 32, 81-84.
http://dx.doi.org/10.1097/BPO.0b013e31823db19d
[13] Garceau, G.J. (1972) Anterior Tibial Tendon Transfer for Recurrent Clubfoot. Clinical Orthopaedics and Related Research, 84, 61-65.
http://dx.doi.org/10.1097/00003086-197205000-00012
[14] Huang, Y.T., Lei, W., Zhao, L. and Wang, J. (1999) The Treatment of Congenital Club Foot by Operation to Correct Deformity and Achieve Dynamic Muscle Balance. The Journal of Bone and Joint Surgery. British Volume, 81, 858-862.
http://dx.doi.org/10.1302/0301-620X.81B5.9354
[15] Hui, J.H., Goh, J.C. and Lee, E.H. (1998) Biomechanical Study of Tibialis Anterior Tendon Transfer. Clinical Orthopaedics and Related Research, 349, 249-255.
http://dx.doi.org/10.1097/00003086-199804000-00031
[16] Lampasi, M., Bettuzzi, C., Palmonari, M. and Donzelli, O. (2010) Transfer of the Tendon of Tibialis Anterior in Relapsed Congenital Clubfoot: Long-Term Results in 38 Feet. The Journal of Bone and Joint Surgery. British Volume, 92, 277-283.
http://dx.doi.org/10.1302/0301-620X.92B2.22504

  
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