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Anterior Tibial Tendon Transfer for Relapsed and Residual Clubfoot Deformity and Functional Outcome With Timely
Irfan Ahmad1, Rana Dilawaiz Nadeem2, Muhammad Ayaz Ul Haq Chatta3
1Trauma & Orthopaedics Surgery, King's College Hospital, London, GBR.
Objective:
To evaluate the functional and clinical outcomes of anterior tibial tendon transfer in patients with relapsed or residual clubfoot deformity presenting with dynamic supination and forefoot adduction after treatment with the Ponseti method.
Materials And Methods:
A retrospective multicentre review was conducted on patients with idiopathic clubfoot treated by the Ponseti method who subsequently developed relapse with forefoot adduction and dynamic supination between January 2019 and January 2024 at Mayo Hospital and Rashid Latif Khan University, Lahore, Pakistan. All procedures were performed by a single surgeon. Forty patients (55 feet) underwent anterior tibial tendon transfer; 23 feet (41.8%) additionally required Achilles tenotomy. Mean age at surgery was 6.2 ± 2.5 years, and mean follow-up was 3.2 ± 1.5 years. Functional and clinical outcomes, along with parental satisfaction, were assessed.
Results:
Among 40 patients (55 feet), 26 (65%) were males and 14 (35%) females; 15 (55%) had bilateral and 25 (45%) unilateral deformities. Mean preoperative score improved from 89.8 ± 12.3 to 134.4 ± 10.5 postoperatively (p < 0.005). Postoperative outcomes were excellent in 45 (81.8%) feet and good in 10 (18.2%) feet. All patients demonstrated improvement in functional grading.
Conclusion:
Anterior tibial tendon transfer resulted in significant improvement in functional outcomes and correction of residual dynamic clubfoot deformity. Early intervention may help achieve correction before the development of rigid deformity.