Tibialis Anterior Tendon Transfer for Relapsing Idiopathic Clubfoot

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