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Published in: Clinical Orthopaedics and Related Research® 2/2014

01-02-2014 | Clinical Research

Is Tibialis Anterior Tendon Transfer Effective for Recurrent Clubfoot?

Authors: Kelly Gray, B App Sc (Physiotherapy), Joshua Burns, PhD, David Little, MBBS, FRACS(Orth), PhD, Michael Bellemore, MBBS, FRACS, Paul Gibbons, MBBS, FRCS(Orth), FRACS

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2014

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Abstract

Background

Tibialis anterior tendon transfer surgery forms a part of Ponseti management for children with congenital talipes equinovarus who, after initial correction, present with residual dynamic supination. Although retrospective studies support good outcomes, prospective longitudinal studies in this population are lacking.

Questions/purposes

We assessed strength, plantar loading, ROM, foot alignment, function, satisfaction, and quality of life in patients with clubfoot that recurred after Ponseti casting who met indications for tibialis anterior tendon transfer surgery, and compared them with a group of patients with clubfoot treated with casting but whose deformity did not recur (therefore who were not indicated for tibialis anterior tendon transfer surgery).

Methods

Twenty children with idiopathic congenital talipes equinovarus indicated for tibialis anterior tendon transfer surgery were recruited. Assessment at baseline (before surgery), and 3, 6, and 12 months (after surgery) included strength (hand-held dynamometry), plantar loading (capacitance transducer matrix platform), ROM (Dimeglio scale), foot alignment (Foot Posture Index©), function and satisfaction (disease-specific instrument for clubfoot), and quality of life (Infant Toddler Quality of Life Questionnaire™). Outcomes were compared with those of 12 age-matched children with congenital talipes equinovarus not indicated for tibialis anterior tendon transfer surgery. Followup was 100% in the control group and 95% (19 of 20) in the tibialis anterior transfer group.

Results

At baseline, the tibialis anterior tendon transfer group had a significantly worse eversion-to-inversion strength ratio, plantar loading, ROM, foot alignment, and function and satisfaction. At 3 months after surgery, eversion-to-inversion strength, plantar loading, and function and satisfaction were no longer different between groups. Improvements were maintained at 12 months after surgery (eversion-to-inversion strength mean difference, 8% body weight; 95% CI, −26% to 11%; p = 0.412; plantar loading, p > 0.251; function and satisfaction, p = 0.076). ROM remained less and foot alignment more supinated in the tibialis anterior tendon transfer group between baseline and followup (p < 0.001, p < 0.001).

Conclusions

Tibialis anterior tendon transfer surgery was an effective procedure, which at 12-month followup restored the balance of eversion-to-inversion strength and resulted in plantar loading and function and satisfaction outcomes similar to those of age-matched children with congenital talipes equinovarus who after Ponseti casting were not indicated for tibialis anterior tendon transfer.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Literature
1.
go back to reference Burns J, Crosbie J, Hunt A, Ouvrier R. The effect of pes cavus on foot pain and plantar pressure. Clin Biomech Bristol, Avon. 2005;20:877–882.PubMedCrossRef Burns J, Crosbie J, Hunt A, Ouvrier R. The effect of pes cavus on foot pain and plantar pressure. Clin Biomech Bristol, Avon. 2005;20:877–882.PubMedCrossRef
2.
go back to reference Burns J, Ouvrier R, Estilow T, Shy R, Laura M, Pallant JF, Lek M, Muntoni F, Reilly MM, Pareyson D, Acsadi G, Shy ME, Finkel RS. Validation of the Charcot-Marie-Tooth disease pediatric scale as an outcome measure of disability. Ann Neurol. 2012;71:642–652.PubMedCentralPubMedCrossRef Burns J, Ouvrier R, Estilow T, Shy R, Laura M, Pallant JF, Lek M, Muntoni F, Reilly MM, Pareyson D, Acsadi G, Shy ME, Finkel RS. Validation of the Charcot-Marie-Tooth disease pediatric scale as an outcome measure of disability. Ann Neurol. 2012;71:642–652.PubMedCentralPubMedCrossRef
3.
go back to reference Dietz FR, Tyler MC, Leary KS, Damiano PC. Evaluation of a disease-specific instrument for idiopathic clubfoot outcome. Clin Orthop Relat Res. 2009;467:1256–1262.PubMedCrossRef Dietz FR, Tyler MC, Leary KS, Damiano PC. Evaluation of a disease-specific instrument for idiopathic clubfoot outcome. Clin Orthop Relat Res. 2009;467:1256–1262.PubMedCrossRef
4.
go back to reference Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop. 1995;4:129–136. Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop. 1995;4:129–136.
5.
go back to reference Escolar DM, Henricson EK, Mayhew J, Florence J, Leshner R, Patel KM, Clemens PR. Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children. Muscle Nerve. 2001;24:787–793.PubMedCrossRef Escolar DM, Henricson EK, Mayhew J, Florence J, Leshner R, Patel KM, Clemens PR. Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children. Muscle Nerve. 2001;24:787–793.PubMedCrossRef
6.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
7.
go back to reference Garceau GJ. Anterior tibial tendon transposition in recurrent congenital club-foot. J Bone Joint Surg Am. 1940;22:932–936. Garceau GJ. Anterior tibial tendon transposition in recurrent congenital club-foot. J Bone Joint Surg Am. 1940;22:932–936.
8.
go back to reference 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 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
9.
go back to reference Hui JH, Goh JC, Lee EH. Biomechanical study of tibialis anterior tendon transfer. Clin Orthop Relat Res. 1998;349:249–255.PubMedCrossRef Hui JH, Goh JC, Lee EH. Biomechanical study of tibialis anterior tendon transfer. Clin Orthop Relat Res. 1998;349:249–255.PubMedCrossRef
10.
go back to reference 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 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
11.
go back to reference 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 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
12.
go back to reference Kuo KN, Hennigan SP, Hastings ME. Anterior tibial tendon transfer in residual dynamic clubfoot deformity. J Pediatr Orthop. 2001;21:35–41.PubMedCrossRef Kuo KN, Hennigan SP, Hastings ME. Anterior tibial tendon transfer in residual dynamic clubfoot deformity. J Pediatr Orthop. 2001;21:35–41.PubMedCrossRef
13.
go back to reference Lampasi M, Bettuzzi C, Palmonari M, Donzelli O. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg Br. 2010;92:277–283.PubMedCrossRef Lampasi M, Bettuzzi C, Palmonari M, Donzelli O. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg Br. 2010;92:277–283.PubMedCrossRef
14.
go back to reference Masrouha KZ, Morcuende JA. Relapse after tibialis anterior tendon transfer in idiopathic clubfoot treated by the Ponseti method. J Pediatr Orthop. 2012;32:81–84.PubMedCrossRef Masrouha KZ, Morcuende JA. Relapse after tibialis anterior tendon transfer in idiopathic clubfoot treated by the Ponseti method. J Pediatr Orthop. 2012;32:81–84.PubMedCrossRef
15.
go back to reference Menz HB. Analysis of paired data in physical therapy research: time to stop double-dipping? J Orthop Sports Phys Ther. 2005;35:477–478.PubMedCrossRef Menz HB. Analysis of paired data in physical therapy research: time to stop double-dipping? J Orthop Sports Phys Ther. 2005;35:477–478.PubMedCrossRef
16.
go back to reference Ponseti I, Morcuende JA, Mosca V, Pirani S, Dietz F, Herzenberg JE, Weinstein S, Penny N, Steenbeek M. Clubfoot: Ponseti Management. Ed 2. In: Staheli L, ed. Seattle, WA: Global-HELP Organization; 2005. Ponseti I, Morcuende JA, Mosca V, Pirani S, Dietz F, Herzenberg JE, Weinstein S, Penny N, Steenbeek M. Clubfoot: Ponseti Management. Ed 2. In: Staheli L, ed. Seattle, WA: Global-HELP Organization; 2005.
17.
go back to reference Ponseti IV, Smoley EN. Congenital club foot: the results of treatment. J Bone Joint Surg Am. 1963;45:261–344. Ponseti IV, Smoley EN. Congenital club foot: the results of treatment. J Bone Joint Surg Am. 1963;45:261–344.
18.
go back to reference Raat H, Landgraf JM, Oostenbrink R, Moll HA, Essink-Bot ML. Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample. Qual Life Res. 2007;16:445–460.PubMedCentralPubMedCrossRef Raat H, Landgraf JM, Oostenbrink R, Moll HA, Essink-Bot ML. Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample. Qual Life Res. 2007;16:445–460.PubMedCentralPubMedCrossRef
20.
go back to reference Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech (Bristol, Avon). 2006;21:89–98. Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech (Bristol, Avon). 2006;21:89–98.
21.
go back to reference Rose KJ, Burns J, Ryan MM, Ouvrier RA, North KN. Reliability of quantifying foot and ankle muscle strength in very young children. Muscle Nerve. 2008;37:626–631.PubMedCrossRef Rose KJ, Burns J, Ryan MM, Ouvrier RA, North KN. Reliability of quantifying foot and ankle muscle strength in very young children. Muscle Nerve. 2008;37:626–631.PubMedCrossRef
22.
go back to reference Roye B, Vitale MG, Gelijns AC, Roye DP Jr. Patient-based outcomes after clubfoot surgery. J Pediatr Orthop. 2001;21:42–49.PubMedCrossRef Roye B, Vitale MG, Gelijns AC, Roye DP Jr. Patient-based outcomes after clubfoot surgery. J Pediatr Orthop. 2001;21:42–49.PubMedCrossRef
23.
go back to reference Thompson GH, Hoyen HA, Barthel T. Tibialis anterior tendon transfer after clubfoot surgery. Clin Orthop Relat Res. 2009;467:1306–1313.PubMedCrossRef Thompson GH, Hoyen HA, Barthel T. Tibialis anterior tendon transfer after clubfoot surgery. Clin Orthop Relat Res. 2009;467:1306–1313.PubMedCrossRef
24.
go back to reference Tulchin K, Jeans KA, Karol LA, Crawford L. Plantar pressures and ankle kinematics following anterior tibialis tendon transfers in children with clubfoot. J Foot Ankle Res. 2012;5(suppl 1):O32.PubMedCentralCrossRef Tulchin K, Jeans KA, Karol LA, Crawford L. Plantar pressures and ankle kinematics following anterior tibialis tendon transfers in children with clubfoot. J Foot Ankle Res. 2012;5(suppl 1):O32.PubMedCentralCrossRef
Metadata
Title
Is Tibialis Anterior Tendon Transfer Effective for Recurrent Clubfoot?
Authors
Kelly Gray, B App Sc (Physiotherapy)
Joshua Burns, PhD
David Little, MBBS, FRACS(Orth), PhD
Michael Bellemore, MBBS, FRACS
Paul Gibbons, MBBS, FRCS(Orth), FRACS
Publication date
01-02-2014
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 2/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-3287-x

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