Skip to main content

Advertisement

SpringerLink
Log in

Tibialis Anterior Tendon Transfer after Clubfoot Surgery

  • Symposium: Clubfoot: Etiology and Treatment
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Recurrent dynamic and structural deformities following clubfoot surgery are commonly due to residual muscle imbalance from a strong tibialis anterior muscle and weak antagonists. We asked whether subcutaneous tibialis anterior tendon transfer effectively treated recurrent deformities following clubfoot surgery and whether the presence of structural deformities influenced the outcome. The patients were divided into two groups: Group I, dynamic supination deformity only (51 patients, 76 feet); and Group II, dynamic supination with other structural deformities (44 patients, 61 feet). The mean age at surgery was 4.3 years (range, 1.4–10.7 years); the minimum followup was 2 years (mean, 5.2 years; range, 2–12.5 years) for both groups. The results were graded according to our subjective rating system of restoration of muscle balance: good, restoration of muscle balance; fair, partial restoration of muscle balance; and poor, no improvement. The two groups had similar outcomes: in Group I, there were 65 good (87%), 11 fair (13%), and no poor results and in Group II, there were 54 good (88%), seven fair (12%), and no poor results. Our data suggest the tibialis anterior tendon transfer restores muscle balance in recurrent clubfeet; we observed no recurrences. This transfer improves function and may prevent secondary osseous changes. We believe the muscle imbalance supports, at least in part, the neuromuscular etiological aspects of congenital clubfeet.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–E
Fig. 2A–C

Similar content being viewed by others

References

  1. Abdelgawad AA, Lehman WB, van Bosse HJ, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B. 2007;16:98–105.

    PubMed  Google Scholar 

  2. Arthornthurasook A, Gew IK. Anterior tibial tendon insertion: an anatomical study. J Med Assoc. Thailand 1990;73:692–696.

    CAS  Google Scholar 

  3. Banker BQ. Neuropathic aspects of arthrogryposis multiplex congenita. Clin Orthop Relat Res. 1972;84:71–78.

    Article  Google Scholar 

  4. Barker S, Chesney D, Miedzybrodzka Z, Maffulli N. Genetics and epidemiology of idiopathic congenital talipes equinovarus. J Pediatr Orthop. 2003;23:265–272.

    Article  PubMed  Google Scholar 

  5. Bill PL, Versfeld GA. Congenital clubfoot. An electromyographic study. J Pediatr Orthop. 1982;2:139–142.

    PubMed  CAS  Google Scholar 

  6. Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J, Bruce CE. Treatment of idiopathic club foot using the Ponseti method. Initial experience. J Bone Joint Surg Br. 2006;88:1385–1387.

    PubMed  CAS  Google Scholar 

  7. Cooper DM, Dietz F. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995;77:1477–1489.

    PubMed  CAS  Google Scholar 

  8. Cowell HR, Wein BK. Current concepts review Genetic aspects of clubfoot. J Bone Joint Surg Am. 1980;62:1381–1384.

    PubMed  CAS  Google Scholar 

  9. Dietz F. The genetics of idiopathic clubfoot. Clin Orthop Relat Res. 2002;401:39–48.

    Article  PubMed  Google Scholar 

  10. Dietz FR. Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique. Instr Course Lect. 2006;55:625–629.

    PubMed  Google Scholar 

  11. Dietz FR, Cole WG, Tosi LL, Carroll NC, Wemer RD, Comstock D. A search for the gene(s) predisposing to idiopathic clubfoot. Clin Genet. 2005;67:361–362.

    Article  PubMed  CAS  Google Scholar 

  12. Dietz FR, Ponseti IV, Buckwater JA. Morphometric study of clubfoot tendon sheaths. J Pediatr Orthop. 1983;3:311–318.

    PubMed  CAS  Google Scholar 

  13. Ester AR, Tyerman G, Wise CA, Blanton SH, Hecht JT. Apoptotic gene analysis in idiopathic talipes equinovarus (clubfoot). Clin Orthop Relat Res. 2007;462:32–37.

    Article  PubMed  Google Scholar 

  14. Ezra E, Hayek S, Gilai AN, Khermosh O, Weintraub S. Tibialis anterior tendon transfer for residual dynamic supination deformity in treated clubfeet. J Pediatr Orthop B. 2000;9:207–211.

    PubMed  CAS  Google Scholar 

  15. Farsetti P, Caterini R, Mancini F, Potenza V, Ippolito E. Anterior tibial tendon transfer in relapsing congenital clubfoot: long-term follow-up study of two series treated with a different protocol. J Pediatr Orthop. 2006;26:83–90.

    Article  PubMed  Google Scholar 

  16. Feldbrin Z, Gilai AN, Erza E, Khermosh O, Kramer U, Weintroub S. Muscle imbalance in the aetiology of idiopathic club foot: an electromyographic study. J Bone Joint Surg Br. 1995;77:596–601.

    PubMed  CAS  Google Scholar 

  17. Fennell CW, Phillips P III. Redefining the anatomy of the anterior tibial tendon. Foot Ankle. 1994;15:396–399.

    PubMed  CAS  Google Scholar 

  18. Fukuhara K, Schollmeier G, Uhthoff HK. The pathogenesis of club foot. A histomorphometric and immuno-chemical study of fetuses. J Bone Joint Surg Br. 1994;76:450–457.

    PubMed  CAS  Google Scholar 

  19. Garceau GJ. Anterior tibial tendon transposition in recurrent congenital club-foot. J Bone Joint Surg Am. 1940;22:932–936.

    Google Scholar 

  20. Garceau GJ. Anterior tibial tendon transfer for recurrent clubfoot. Clin Orthop Relat Res. 1972;84:61–65.

    Article  PubMed  CAS  Google Scholar 

  21. Garceau GJ, Palmer RM. Transfer of the anterior tibial tendon for recurrent club foot. A long-term follow-up. J Bone Joint Surg Am. 1967;49:207–231.

    PubMed  CAS  Google Scholar 

  22. Gray DH, Katz JM. A histochemical study of muscle in clubfoot. J Bone Joint Surg Br. 1981;63:417–423.

    PubMed  Google Scholar 

  23. Haft GF, Walker CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am. 2007;89:487–493.

    Article  PubMed  Google Scholar 

  24. Handelsman J, Badalamente MA. Neuromuscular studies in clubfoot. J Pediatr Orthop. 1981;1:23–31.

    PubMed  CAS  Google Scholar 

  25. Herceg MB, Weiner DS, Agamanolis DP, Hawk D. Histologic and histochemical analysis of muscle specimens in idiopathic talipes equinovarus. J Pediatr Orthop. 2006;26:91–93.

    Article  PubMed  Google Scholar 

  26. Hoffer MM, Reiswig JA, Garrett AM, Perry J. The split anterior tibial tendon transfer in the treatment of spastic varus hindfoot of childhood. Orthop Clin North Am. 1974;5:31–38.

    PubMed  CAS  Google Scholar 

  27. Hui JHP, Goh JHC, Lee EH. Biomechanical study of tibialis anterior tendon transfer. Clin Orthop Relat Res. 1998;349:249–255.

    Article  PubMed  Google Scholar 

  28. Ionasescu V, Maynard JA, Ponseti IV, Zelleweger H. The role of collagen in the pathogenesis of idiopathic club foot. Biochemical and electron microscopic correlations. Helv Paediatr Acta. 1974;29:305.

    PubMed  CAS  Google Scholar 

  29. Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003;85:1286–1294.

    PubMed  Google Scholar 

  30. Ippolito E, Ponseti IV. Congenital clubfoot in the human fetus. A histological study. J Bone Joint Surg Am. 1980;62:8–22.

    PubMed  CAS  Google Scholar 

  31. Ippolito E, Ricciardi-Pollini PT, Tudisco C, Ronconi P. The treatment of relapsing clubfoot by tibialis anterior transfer underneath the extensor retinaculum. Ital J Orthop Traumatol. 1985;11:171–177.

    PubMed  CAS  Google Scholar 

  32. Irani RN, Sherman MS. The pathological anatomy of idiopathic clubfoot. Clin Orthop Relat Res. 1972;84:14–20.

    Article  PubMed  CAS  Google Scholar 

  33. Isaacs H, Handelsman JE, Badenhorst M, Pickering A. The muscles in club foot–a histological, histochemical and electron microscopy study. J Bone Joint Surg Br. 1977;59:465–472.

    PubMed  Google Scholar 

  34. Karol LA, Concha MC, Johnston CE 2nd. Gait analysis and muscle strength in children with surgically treated clubfeet. J Pediatr Orthop. 1997;17:790–795.

    Article  PubMed  CAS  Google Scholar 

  35. Khan AM, Ryan MG, Gruber MM, Haralabatos SP, Badalamente MA. Connective tissue structures in clubfoot: a morphologic study. J Pediatr Orthop. 2001;21:708–712.

    Article  PubMed  CAS  Google Scholar 

  36. Kuo KN, Hennigan SP, Hastings ME. Anterior tibial transfer in residual dynamic clubfoot deformity. J Pediatr Orthop. 2001;21:35–41.

    PubMed  CAS  Google Scholar 

  37. Kuo KN, Jansen LD. Rotatory dorsal subluxation of the navicular: a complication of clubfoot surgery. J Pediatr Orthop. 1998;18:770–774.

    Article  PubMed  CAS  Google Scholar 

  38. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62:23–31.

    PubMed  CAS  Google Scholar 

  39. Laville JM, Bussieres F. Role of Cahuzac’s operation in clubfoot varus equina revision surgery [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1998;84:638–645.

    PubMed  CAS  Google Scholar 

  40. Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998;79:90–96.

    Article  PubMed  CAS  Google Scholar 

  41. Loren GJ, Karpinski NC, Mubarak SJ. Clinical implications of clubfoot histopathology. J Pediatr Orthop. 1998;18:765–769.

    Article  PubMed  CAS  Google Scholar 

  42. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004;113:376–380.

    Article  PubMed  Google Scholar 

  43. Ponseti IV. Current concepts review. Treatment of congenital club foot. J Bone Joint Surg Am. 1992;74:448–454.

    PubMed  CAS  Google Scholar 

  44. Ponseti IV. Congenital clubfoot: fundamentals of treatment. New York, NY: Oxford Medical Publications; 1996:84.

    Google Scholar 

  45. Ponseti IV, Campos J. Observations on pathogenesis and treatment of congenital club foot. Clin Orthop Relat Res. 1972;84:50–60.

    Article  PubMed  CAS  Google Scholar 

  46. Ricciardi-Pollini PT, Ippolito E, Tudisco C, Farsetti P. Congenital clubfoot: results of treatment of 54 cases. Foot Ankle. 1984;5:107–117.

    PubMed  CAS  Google Scholar 

  47. Roye DP Jr, Roye BD. Idiopathic congenital talipes equinovarus. J Am Acad Orthop Surg. 2002;10:239–248.

    PubMed  Google Scholar 

  48. Settle GW. The anatomy of congenital talipes equinovarus. Sixteen dissected specimens. J Bone Joint Surg Am. 1963;45:1341–1354.

    CAS  Google Scholar 

  49. Shapiro F, Glimcher MJ. Gross and histological abnormalities of the talus in congenital Clubfoot. J Bone Joint Surg Am. 1979;61:522–530.

    PubMed  CAS  Google Scholar 

  50. Singer M, Fripp AT. Tibialis anterior transfer in congenital club foot. J Bone Joint Surg Br. 1958;40:252–255.

    PubMed  Google Scholar 

  51. Sodre H, Bruschini S, Mestriner LA, Miranda F Jr, Levinsohn EM, Packard DS Jr, Crider RI Jr, Schwartz R, Hootnick DR. Arterial abnormalities in talipes equinovarus as assessed by angiography and the doppler technique. J Pediatr Orthop. 1990;10:101–104.

    PubMed  CAS  Google Scholar 

  52. Tarraf YN, Carroll NC. Analysis of the components of residual deformity in clubfeet presenting for reoperation. J Pediatr Orthop. 1992;12:207–216.

    PubMed  CAS  Google Scholar 

  53. Thompson GH, Richardson AB, Westin GW. Surgical management of resistant congenital talipes equinovarus deformities. J Bone Joint Surg Am. 1982;64:652–665.

    PubMed  CAS  Google Scholar 

  54. Zimny ML, Willig SJ, Roberts JM, D’Ambrosia RD. An electron microscopic study of the fascia from the medial and lateral sides of clubfoot. J Pediatr Orthop. 1985;5:577–581.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank PariAnne Fatica in her transcription and correspondence regarding this manuscript.

Author information

Authors and Affiliations

  1. Division of Pediatric Orthopaedics, Rainbow Babies and Children’s Hospitals, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    George H. Thompson MD

  2. MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Harry A. Hoyen MD

  3. Valley Orthopaedic Associates, Seattle, WA, USA

    Tracey Barthel MD

Authors
  1. George H. Thompson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harry A. Hoyen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tracey Barthel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George H. Thompson MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Thompson, G.H., Hoyen, H.A. & Barthel, T. Tibialis Anterior Tendon Transfer after Clubfoot Surgery. Clin Orthop Relat Res 467, 1306–1313 (2009). https://doi.org/10.1007/s11999-009-0757-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-0757-2

Keywords

Search

Navigation