Essential Surgical Techniques

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Core surgical procedures that all orthopaedic surgeons need to know.

Latest Surgical Technique

August 26, 2015
  • Joshua B. Holt , MD
  • Brian Westerlind , BA
  • Jose A. Morcuende , MD, PhD
  1. Joshua B. Holt, MD1,
  2. Brian Westerlind, BA1 and
  3. Jose A. Morcuende, MD, PhD1
  1. 1Ponseti Clubfoot Treatment Center, Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242

Introduction 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.

Step 1: Preoperative Planning Ensure that the foot has been adequately corrected for tendon transfer by performing both clinical and radiographic evaluation.

Step 2: Prepare the Patient Position the patient supine, induce general anesthesia, and perform a caudal block for postoperative pain management.

Step 3: Identify and Release the Tibialis Anterior Tendon from Its Insertion Identify the tibialis anterior tendon and release its insertion on the medial cuneiform and first metatarsal bones.

Step 4: Prepare the Tendon and Surrounding Tissues for Transfer Release obstructing tissues and prepare the freed tendon for lateral transfer to the mid-dorsum of the foot.

Step 5: Prepare the Lateral Cuneiform for Tendon Transfer and Fixation Identify the lateral cuneiform with fluoroscopy and prepare it for transfer of the tibialis anterior tendon.

Step 6: Transfer and Secure the Tendon Make a subcutaneous path, transfer the tendon, and secure it in the osseous tunnel of the lateral cuneiform.

Step 7: Postoperative Care We apply a long leg cast and restrict patients to non-weight-bearing for six weeks.

Results The tibialis anterior tendon transfer has been used to treat relapsing idiopathic clubfoot with great success for more than fifty years.

Indications

Contraindications

Pitfalls & Challenges

Introduction

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.

It has been reported that 7% to 56% of patients have a relapse of the deformity after initial treatment of idiopathic clubfoot with the Ponseti method of serial manipulations and casts1,2. Relapse is identified by a dynamic supination deformity during walking and progressive …

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