Split Tibialis Anterior Transfer for Correction of Residual Dynamic Metatarsus Adductus Following Ponseti Management of Idiopathic Clubfoot

Background: Clubfoot represents one of the most common congenital orthopedic deformities.It affects 1-2/1000 live births all over the world.Cases of dynamic and severe deformity represent a challenging problem.This is because the conservative management is not effective as well as the surgical options are little.Objective: Aim of the present study was to evaluate the better management of split tibialis anterior tendon transfer in the treatment of residual clubfoot.Patients and methods: Eighteen cases (22 feet) with residual dynamic supination deformity following previous Ponseti management underwent split transfer of the anterior tibial tendon.This was a prospective study between March 2020 and February 2021, the cases were collected and the study was carried out at Zagazig University Hospitals.Results: In our study, the mean age was 41.05 months (ranged from 30 to 59 months).Out of the 18 patients, there were 12 males and 6 females.Four cases (22.2%) were bilaterally affected.While 14 patients (77.8%) were one-side affected (5 left foot affected and 9 right foot affected).Our results showed marked improvement of patients according to Garceau and Palmer's criteria as the mean pre-operative assessment was 2.5 reaching 3.28 post-operatively.14 patients (88.9%) were either poor or fair and no single patient was excellent pre-operatively, while postoperatively all patients became either excellent mostly or good. Conclusion:Anterior tibial tendon transfer is a reasonable method of achieving the objective, either fully or split transfer because both operations have excellent results with low rate of major complications.It's very simple but yet very effective soft-tissue procedure to correct the muscle imbalance of the foot.