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.
Pitfalls & Challenges
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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