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The role of the posterior tibial muscle in producing foot deformities has been stressed in the literature. The importance of releasing the posterior tibial tendon in correcting an equinovarus deformity has been well recognized. A review of the literature, however, reveals that transplantation of the posterior tibial tendon through the interosseous space is not a well known operative procedure. Transplantation of the posterior tibial muscle and tendon through the interosseous space is a valuable operative procedure and can be relied upon to restore active dorsiflexion of the foot. The operation is applicable to a wide variety of conditions in which the posterior tibial muscle has good power and there is a need for an additional dorsiflexor of the foot.

The diagnostic features in four cases of spontaneous rupture of the posterior tibial tendon were pain distal and posterior to the medial malleolus, loss of stability of the foot, and the absence of posterior tibial function. The functional results were fair following surgical repair of the ruptured tendon. The contributory role of antecedent non-specific tenosynovitis was documented in three cases.

OBSERVATIONS of four cases of posterior tibial tenosynovitis in which anomalies of the tendon were found at surgical exploration has prompted a review of this subject. The syndrome of noninfectious tenosynovitis was first described by Velpeau, in 1818, and again in 1825.1The work of de Quervain,2in 1895, and of many others since has served to emphasize the importance of this condition as a cause of painful symptoms, particularly about the wrist and ankle. Kulowski,3in 1936, was the first to mention tenosynovitis of the sheath of the posterior tibial tendon. This was also noted by Lipscomb,4who stated that it occurred in about 16% of cases of tenosynovitis and peritendinitis of the feet and ankles. Lapidus and Seidenstein5reported three cases of tenosynovitis with effusion involving the sheath of the posterior tibial tendon. Lipscomb noted anatomic variations of the tendons within the posterior

Summary 1. Anterior transplantation of the posterior tibial tendon between the tibia and fibula is described. 2. Application of this operative procedure in certain cases of congenital club foot and poliomyelitis is discussed. 3. This operation is considered effective in restoring muscle balance in selected cases of these two disabilities.

SUMMARY The paper presents two tests for evaluating the functional activity of the posterior tibial muscle in patients with spastic cerebral palsy. These tests help to determine whether or not the posterial tibial muscle is the deforming agent in the toe-in or adduction gait pattern. In addition, helpful information can be derived from these tests when planning a transfer of the posterior tibial tendon. RESUME Examen fonctionnel du muscle jambier posterieur dans la paralysie spastique L'auteur presente deux tests pour l'evaluation de l'activite fonctionnelle du muscle jambier posterieur chez des malades atteints de paralysie cerebrale spastique. Ces tests servent a determiner si ou non le muscle jambier posterieur est l'agent deformant dans la demarche avec adduction. En addition, on peut en tirer des precisions utiles si un deplacement du tendon jambier posterieur est envisagee. ZUSAMMENFASSUNG Funktionstest des M. tibialis posterior bei der Spastischen Paralyse Es werden zwei Tests zur Ermittlung der funktionellen Aktivitat des M. tibialis posterior bei Patienten mit spastischer cerebraler Lahmung beschrieben. Diese Untersuchungen helfen bei der Entscheidung, ob der M. tibialis posterior fur die Deformierung bei der Zeheneinwartsstellung oder beim Adduktorengang verantwortlich ist oder nicht. Auserdem kann von diesen Untersuchungen wertvolle Information gewonnen werden, wenn eine Verpflanzung der Tibialis posterior–Sehne geplant ist. RESUMEN Examen funcional del musculo tibial posterior en las paralisis espasticas Se exponen dos ‘tests’ para evaluar la actividad funcional del musculo tibial posterior en pacientes con paralisis cerebral espastica. Estos ‘tests’ ayudan a definir si el citado musculo es el agente deformante en la marcha con aduccion. Ademas estos ‘tests’ pueden facilitar information util cuando se trata de realizar un trasplante del tendon del tibial posterior.

In 1929 I1described an operation for the correction of certain cases of intractable flatfoot by the removal of the prehallux or accessory scaphoid and transplantation of the posterior tibial tendon. In that article the literature was reviewed and a bibliography given. It was stated that the prehallux is a common and frequently unrecognized anomaly which, by changes in leverage, interferes with the normal mechanics of the action of the posterior tibial muscle and thus produces weakness of the longitudinal arch and flatfoot of a type highly resistant to the usual conservative methods of treatment. It was also stated that in the presence of the prehallux, whether as a separate bone or as a prolongation inward of the scaphoid, there is an abnormal insertion of the tibialis posticus tendon. Instead of passing under the inner end of the scaphoid to insert in the lower surface of the two internal