Comparing Indications and Techniques of the Tibialis Anterior Tendon Transfer Between Clubfoot Centres in the Netherlands

Introduction Idiopathic clubfoot is a common congenital anomaly that is treated with the Ponseti method in accordance with the guidelines showing excellent results. Nevertheless, relapse may occur for which a tibialis anterior tendon transfer (TATT) has been described as a useful treatment. However, a guideline describing the exact indication, surgical techniques and postoperative care of a TATT is not available yet. The aim of this study is to provide a survey-based overview of the pre-, peri- and postoperative steps of the various methods that are used to perform the TATT procedure throughout the Netherlands. Materials and methods An online survey was created, based on a literature review, and sent to the paediatric orthopaedic surgeons working at 11 different clubfoot centres in the Netherlands. We received nine complete responses from seven out of 11 (64%) orthopaedic centres. The data was collected through the online survey software Qualtrics^XM (Qualtrics, LLC, Provo, Utah, USA). Results The results showed that the TATT procedures differ from one another. How the surgical procedures were performed, in particular, varied to a great extent. However, the majority of clubfoot centres were in agreement when it comes to the age at which the TATT is performed (four to nine) and the postoperative treatment. Moreover, the respondents expressed a mean outcome satisfaction of 7.8 with very little variation. Discussion Based on these results, we conclude that there is a considerable variation between the TATT procedures in different clubfoot centres throughout the Netherlands. Despite this variation in execution, variation in satisfaction outcome among physicians remains limited. However, we do not know whether the satisfaction outcomes match the actual results. Thus, further research into the various methods and their results is required in order to compose adequate and standardised guidelines surrounding the TATT and optimise clubfoot care, keeping in mind that there is more than one way to bake a cake.