Efficacy of Total Tibialis Anterior Tendon Transfer using Button Anchor in Management of Residual Dynamic Supination in Congenital Talipes Equino Varus.

INTRODUCTION: Congenital talipes equino-varus (CTEV) is amongst one of the most common paediatric foot deformities. Ponseti's method is the standard way of treatment, however, some patients are left with residual or partially corrected deformities. Dynamic supination is one amongst them, where the foot supinates in swing phase of the gait cycle. It is due to a strong tibialis anterior and its weak antagonist.

MATERIALS AND METHODS: We undertook a prospective interventional study in thirty patients of CTEV with residual dynamic supination deformity and treated them with tibialis anterior tendon transfer (TATT) using a button anchor. Minimum follow-up was six months after the surgery. Functional, subjective and objective evaluation was done using foot posture index (FPI), disease specific instrument (DSI) for clubfoot, clinician satisfaction grading and videotaped functional gait analysis. Statistical analysis was done using paired 't' test and calculating p values.

RESULTS: We achieved good to excellent results in 93.3% of our patients and fair in 6.66%. None of our patients had poor results. Mean FPI improved from -1.93 to +0.3, DSI values also showed a significant reduction from 18.17 +/- 1.09 to 13.37 +/- 1.54 after surgery. A total of 90% had satisfactory gait post-surgery at 6 months follow-up.

CONCLUSION: Tibialis anterior tendon transfer using a button anchor is effective in treatment of residual dynamic supination deformity.