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Long-term results show efficacy of anterior tibialis transfer for clubfoot relapse patients

A 50-year follow-up showed no significant difference in dorsiflexion, similar QOL to non-ATT-treated patients.

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SAN DIEGO — Patients treated with anterior tibialis tendon transfer for idiopathic clubfoot relapse continue to show good results 50 years after undergoing the surgery, according to a study presented here.

Jose A. Morcuende, MD, and colleagues in Iowa City, Iowa, evaluated the long-term outcomes for 35 patients treated for idiopathic clubfoot between 1950 and 1967. Of these patients, 14 underwent anterior tibialis tendon (ATT) transfer for relapse at a mean age of 5 years. The researchers compared their results to those for the remaining 21 patients, which did not undergo ATT transfer.

David E. Oji, BA, first author of the study, presented the results here at the American Academy of Orthopaedic Surgeons annual meeting.

The researchers found that the patients treated with ATT transfer for relapse had similar long-term outcomes compared to non-ATT transfer-treated patients. At 50 years' follow-up, neither group had experienced a further relapse or required additional clubfoot surgeries, Oji said.

Clinical evaluations showed slightly higher dorsiflexion for patients in the non-ATT-treated group, which averaged 4.8° vs. 3.4° for the ATT transfer group. The difference did not reach statistical significance, however.

ATT patients performed more toe-ups than the comparison group. They also had a smaller AP talocalcaneal angle (P<.048) and slightly more talar flattening (P<.03). But investigators found no significant differences on surface EMG comparing the ATT group with non-ATT patients and normal subjects.

The researchers also found no significant differences between groups in Laaveg-Ponsetti Clubfoot Questionnaire scores, Foot Function Index scores and Foot and Ankle Baseline Questionnaire results using the Short Form-36 (SF-36).

Both groups had similar rates of Achilles tendon calcification, found in two patients in each group.

"The ATT patients had more sever need, requiring more treatment than recasting alone," Oji said.

"At 50-year follow-up, ATT patients had no further reoperation after the procedure. They had an inner ankle range of motion and had a similar quality-of-life compared to controls and to the normal population for the SF-36 score. And finally, at the present time, we do not know the clinical implication of the Achilles tendon calcification on outcome," he said.

For more information:

• Oji DE, Lovell M, Dolan L, et al. Long-term results of anterior tibialis transfer in idiopathic clubfeet. A 50-year follow-up study. #387. Presented at the 74th Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 14-17. 2007. San Diego.