Posterior tibial tendon transfer in spastic equinovarus

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Biomechanics

Background:

• Spastic equinovarus is a challenging foot deformity often resulting from neurological conditions.
• Traditional bracing and surgical interventions have varying degrees of success.
• Posterior tibial tendon dysfunction can significantly impact gait and foot alignment.

Purpose of the Study:

• To evaluate the efficacy of posterior tibial tendon transfer through the interosseous membrane for correcting spastic equinovarus.
• To identify key factors influencing successful surgical outcomes in pediatric patients.

Main Methods:

• A retrospective review of 28 pediatric patients undergoing posterior tibial tendon transfer through the interosseous membrane.
• Assessment of gait, brace usage, heel alignment, and overall functional scores post-surgery.

Main Results:

• All 28 patients demonstrated improved gait following the procedure.
• 82% of patients were able to discontinue brace use.
• Good or satisfactory foot-strike at the stance phase was achieved in 82% of patients.
• 68% achieved a neutral heel position.
• Overall good or satisfactory outcomes were reported in 89% of patients (68% good, 21% satisfactory).

Conclusions:

• Posterior tibial tendon transfer through the interosseous membrane is an effective surgical option for spastic equinovarus.
• Key factors for successful outcomes include the absence of fixed varus deformity, patient age between 5-10 years, and precise tendon reinsertion.
• This procedure offers significant functional improvement and reduced reliance on bracing in pediatric populations.