Tibialis anterior tendon transfer after clubfoot surgery.

UNLABELLED: Recurrent dynamic and structural deformities following clubfoot surgery are commonly due to residual muscle imbalance from a strong tibialis anterior muscle and weak antagonists. We asked whether subcutaneous tibialis anterior tendon transfer effectively treated recurrent deformities following clubfoot surgery and whether the presence of structural deformities influenced the outcome. The patients were divided into two groups: Group I, dynamic supination deformity only (51 patients, 76 feet); and Group II, dynamic supination with other structural deformities (44 patients, 61 feet). The mean age at surgery was 4.3 years (range, 1.4-10.7 years); the minimum followup was 2 years (mean, 5.2 years; range, 2-12.5 years) for both groups. The results were graded according to our subjective rating system of restoration of muscle balance: good, restoration of muscle balance; fair, partial restoration of muscle balance; and poor, no improvement. The two groups had similar outcomes: in Group I, there were 65 good (87%), 11 fair (13%), and no poor results and in Group II, there were 54 good (88%), seven fair (12%), and no poor results. Our data suggest the tibialis anterior tendon transfer restores muscle balance in recurrent clubfeet; we observed no recurrences. This transfer improves function and may prevent secondary osseous changes. We believe the muscle imbalance supports, at least in part, the neuromuscular etiological aspects of congenital clubfeet. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.