Split versus full tibialis anterior tendon transfer in treatment of residual dynamic supination in treated idiopathic clubfoot by Ponseti method

Background
Dynamic supination is a common sequelae following successful nonoperative treatment of clubfoot with the Ponseti technique. It is resulted from a strong tibialis anterior muscle and weak antagonists, particularly the peroneal and tibialis posterior muscles. Tendon-balancing procedure is the most reasonable solution. Use of tibialis anterior tendon transfer (TATT) in recurrent clubfoot deformities has been described since 1940.
Patients and methods
Through this study, we compare the results of split versus full TATT in the treatment of residual dynamic supination in treated idiopathic clubfoot by Ponseti method. Patients were divided into two groups. The first group (nine patients with 10 feet) (group I) consists of the patients who were managed with split tendon transfer and the second group (nine patients with 10 feet) (group II) consists of the patients who managed with full tendon transfer. Garceau and Palmer’s clinical criteria and a grading system proposed by Thompson and colleagues were used for evaluation of the results of tendon transfer either split or full.
Results
A total of 18 children (13 males and five females) were involved in this study. The average of the age of the children in group I was 4.3 years and in group II was 4 years at the time of surgery. According to Garceau and Palmer’s clinical criteria, in group I, the preoperative ratings of 10 feet were as follows: four feet were good and six feet were fair, with scores of 3 points and 2 points, respectively. The postoperative ratings were five feet were excellent and five feet were good, with scores of 4 points and 3 points, respectively, with a statistically significant improvement (<0.05). In group II, the preoperative ratings of 10 feet were six feet were good and four feet were fair, with scores of 3 points and 2 points, respectively. The postoperative ratings were six feet were excellent and four feet were good, with scores of 4 points and 3 points, respectively, with a statistically significant improvement (<0.01). In comparing the results of both groups, no statistically significant relation could be found (>0.05). According to the grading system proposed by Thompson and colleagues for restoration of muscle balance, in group I, eight feet achieved good results and two feet achieved fair results, whereas in group II, seven feet achieved good result and three feet achieved fair results. In comparing the results of both groups, we found there was no statistically significant relation (>0.05).
Conclusion
TATT is an excellent method of correcting residual dynamic clubfoot deformity and there is no significant difference in the results by either full transfer or split transfer, and the surgeon’s preference plays a major role in selection of the procedure.