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Tibialis Anterior Tendon Transfer for Relapsing Idiopathic Clubfoot
Joshua B Holt1, Brian Westerlind1, Jose A Morcuende1
1Ponseti Clubfoot Treatment Center, Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242.
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.IndicationsContraindicationsPitfalls & Challenges.
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