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Thursday, March 1, 2001

Tendon transfer excellent for club foot management

Residual dynamic deformity of the forefoot is not uncommon in children with previous clubfoot release. The forefoot is supinated and adducted secondary to overpowering the anterior tibia tendon. Coauthors of study in scientific exhibit 63 reviewed the efficacy of anterior tibia tendon transfer and found it is an excellent procedure in clubfoot management.

"It produces measurable correction in radiographs and improves eversion strength," the investigators said. "Clinically, by Garceau's criteria, it definitely provides a better plantar grade foot. While full anterior tibial tendon gave eversion power and supination correction, the split anterior tibia tendon transfer had better preservation of inversion function."

From 1975 to 1988, 55 children (71 feet) with residual dynamic clubfoot deformity underwent anterior tibia tendon transfer. Among them, 42 feet had full anterior tibia tendon transfer, while 29 feet had split anterior tibia tendon transfer. Average age of full transfer was 5.3 years and split transfer 6.6 years with average follow-up of 8.8 years.

Clinical evaluations were done according to Garceau's criteria and radiographic evaluations were done using AP and lateral standing views of the foot.

The investigators said all patients showed significant improvement and upgrading of grouping by Garceau's criteria following surgery with no significant difference between full and split transfer. The most common location of full transfer group was lateral cuneiform and in the split transfer the cuboid. There was significant statistical improvement in ankle dorsiflexion postoperative in both groups by 6.9 degrees and plantar flexion by 3.5 degrees. There was no loss of muscle strength in dorsiflexion following transfer. Patients showed improvement in eversion averaging 1.5 grades.

Radiographically, Talo-1st metatarsal angle correction was significant in AP standing view. First and fifth metatarsal overlap measurement showed significant improvement in lateral standing view.

It is an excellent procedure in clubfoot management for correcting dynamic forefoot supination and adduction deformity.

The investigators are Ken N. Kuo, MD, and Shawn P. Hennigan, MD, both of Rush Presbyterian St. Luke's Medical Center, Rush University, Chicago, Ill.

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2001 Academy News March 1 Index B

Last modified 20/February/2001 by IS