Tibialis Anterior Tendon Transfer for Relapsing Idiopathic Clubfoot.

Introduction: A relapsed idiopathic clubfoot can be effectively treated with transfer of the entire tibialis anterior tendon to the mid-dorsum of the foot following repeated manipulations and serial casts.
Step 1 Preoperative Planning: Ensure that the foot has been adequately corrected for tendon transfer by performing both clinical and radiographic evaluation.
Step 2 Prepare the Patient: Position the patient supine, induce general anesthesia, and perform a caudal block for postoperative pain management.
Step 3 Identify and Release the Tibialis Anterior Tendon From Its Insertion: Identify the tibialis anterior tendon and release its insertion on the medial cuneiform and first metatarsal bones.
Step 4 Prepare the Tendon and Surrounding Tissues for Transfer: Release obstructing tissues and prepare the freed tendon for lateral transfer to the mid-dorsum of the foot.
Step 5 Prepare the Lateral Cuneiform for Tendon Transfer and Fixation: Identify the lateral cuneiform with fluoroscopy and prepare it for transfer of the tibialis anterior tendon.
Step 6 Transfer and Secure the Tendon: Make a subcutaneous path, transfer the tendon, and secure it in the osseous tunnel of the lateral cuneiform.
Step 7 Postoperative Care: We apply a long leg cast and restrict patients to non-weight-bearing for six weeks.
Results: The tibialis anterior tendon transfer has been used to treat relapsing idiopathic clubfoot with great success for more than fifty years.IndicationsContraindicationsPitfalls & Challenges.