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Relapse After Tibialis Anterior Tendon Transfer in Idiopathic Clubfoot Treated by the Ponseti Method

Masrouha, Karim Z. MD; Morcuende, José A. MD, PhD

doi: 10.1097/BPO.0b013e31823db19d

Background: The Ponseti method for clubfoot correction has demonstrated excellent results. However, relapses are common and continue to be the most important problem facing clubfoot practitioners. Relapses usually require repeated casting and/or surgical intervention with tibialis anterior tendon transfer (TATT). However, recent data on relapses suggest that performing a successful TATT may not be a definitive cure as there may be other processes, such as neuromuscular deficits, that may result in subsequent relapses.

Methods: The authors reviewed 66 patients (102 clubfeet) treated by TATT for clubfoot relapses after successful initial treatment by the Ponseti method. Ten patients (15 clubfeet) experienced a subsequent relapse. Demographic, clinical, and treatment data was recorded.

Results: These patients had a tendency toward a greater number of casts at initial treatment (P=0.14) and they underwent relapse surgery earlier than those who did not relapse after TATT (P=0.05). Two of these patients had a neuromyopathy, diagnosed by muscle biopsy. The treatment of post-TATT relapse included casting (6 patients), ankle foot orthotic (4 patients), physical therapy (2 patients), or bracing (1 patient). One patient was treated by osteotomies of the cuboid and medial cuneiform and 1 patient had a peroneus longus to peroneus brevis tendon transfer.

Conclusions: Performing a TATT may not be the definitive treatment for clubfoot relapses as neuromuscular deficits may be involved. In addition, these patients may be at an increased risk of relapse due to the earlier age at which TATT was performed. When there is a high index of suspicion, prompt diagnosis with muscle biopsy is warranted.

Level of Evidence: Level III (Case-control study).

Department of Orthopaedic Surgery and Rehabilitation, The Ponseti Clubfoot Treatment Center, University of Iowa City, IA

The authors declare no conflict of interest.

Reprints: José A. Morcuende, MD, PhD, Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01023 JPP, Iowa City, IA 52242. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.