Tibialis anterior transfer for calcaneal deformity: a postoperative gait analysis

We retrospectively evaluated seven children who had low-lumbar-level spina bifida and who had undergone bilateral transfer of tibialis anterior to the calcaneus. The mean age at the time of operation was 8 years (range, 3-12), and the patients were monitored for an average of 40 months (range, 24-60). All children underwent a postoperative gait analysis to assess the function of the transfer and the need for continued postoperative bracing. Transfer of the tibialis anterior muscle to the calcaneus arrested progression of the calcaneal deformity; however, the transfer could not prevent excessive dorsi-flexion of the ankle during stance. The use of a pretibial ankle-foot orthosis improved velocity, increased stride length, decreased quadriceps activity at terminal stance, and led to decreased energy expenditure. We conclude that continued bracing is necessary to provide a more normal appearing and energy-efficient gait.