Split Posterior Tibial Tendon Transfer for Spastic Equinovarus Foot Deformity

This paper describes a simplified technique for split posterior tibial tendon transfer in the treatment of spastic equinovarus deformity of the foot. Thirteen children with spastic equinovarus foot deformities were treated at Children's Rehabilitative Services in Phoenix, Arizona, from 1983 to 1986. The technique was modified in 10 of the 13 patients by attaching the split posterior tibial tendon more proximally to the peroneus brevis, compared to a more distal attachment as described by other authors. The mean length of followup was 21 months. Eleven patients obtained a good or excellent result. Two patients were considered to have a fair result. No poor results or complications were noted in any of the patients. It was felt that the split posterior tibial tendon transfer was an effective procedure for correction of spastic equinovarus as reported by other authors. Modification of the technique significantly simplifies the operation by requiring less dissection while still producing favorable results.

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Outcome Following Addition of Peroneus Brevis Tendon Transfer to Treatment of Acquired Posterior Tibial Tendon Insufficiency

Foot & Ankle International ◽

10.1177/107110070102200405 ◽

2001 ◽

Vol 22 (4) ◽

pp. 301-304 ◽

Cited By ~ 16

Author(s):

Suzette J. Song ◽

Jonathan T. Deland

Keyword(s):

Tendon Transfer ◽

Posterior Tibial Tendon ◽

Posterior Tibial ◽

Peroneus Brevis

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Posterior Tibial Tendon Transfer and Tendo-Achilles Lengthening for Equinovarus Foot Deformity Due to Severe Crush Injury

Foot & Ankle International ◽

10.1177/107110070202301204 ◽

2002 ◽

Vol 23 (12) ◽

pp. 1103-1106 ◽

Cited By ~ 2

Author(s):

Ali Sabri Atesalp ◽

Cemil Yıldız ◽

Mahmut Kömürcü ◽

Mustafa Basbozkurt ◽

Ethem Gür

Keyword(s):

Tendon Transfer ◽

Operative Procedure ◽

Varus Deformity ◽

Crush Injury ◽

Posterior Tibial Tendon ◽

Foot Deformity ◽

Posterior Tibial ◽

Tendon Lengthening ◽

Achilles Tendon Lengthening

Surgical correction was performed on nine patients who had equinovarus deformity caused by severe crush injury of the leg sustained in an earthquake. The operative procedure used involved the transfer of the posterior tibial tendon to the dorsum of the foot by passing it through the interosseous membrane using a modified procedure as published in 1978. 5 This procedure was combined with percutaneous Achilles tendon lengthening and tenotomy of toe flexors when needed. The average follow-up time after the operation was 21 months. The treatment improved the heel-toe steppage gait in all patients and all were able to walk in standard shoes. There were no complications in the postoperative period. Recurrence of varus deformity was not seen in any of the patients. They had active dorsiflexion of the foot, with a median active dorsiflexion of 5° (0 to 10°) and median active plantarflexion of 16.1° (10 to 25°) compared to the median active dorsiflexion and plantarflexion on the uninvolved side. The total range-of-motion was 21.1° (10 to 35°).

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PO 18205 - Case report

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1033 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 45S

Author(s):

Rui Dos Santos Barroco ◽

Antonio Candido de Paula Neto ◽

Douglas Hideki Ikeuti ◽

Letícia Zaccaria Prates de Oliveira ◽

Bruno Rodrigues De Miranda ◽

...

Keyword(s):

Soft Tissue ◽

Conservative Treatment ◽

Tendon Transfer ◽

Tendon Rupture ◽

Posterior Tibial Tendon ◽

Longus Tendon ◽

Posterior Tibial ◽

Extensor Hallucis Longus ◽

Anterior Tibial ◽

Peroneus Brevis

Introduction: Anterior tibial tendon ruptures are quite rare. All studies found in the literature refer to the adult population, with no reports of this injury in the pediatric population. The literature on the treatment of this injury is scarce. Objective: To report the case of a child subjected to peroneus brevis tendon transfer for the sequela of a severe anterior tibial and extensor hallucis longus tendon injury. Methods: Male patient, 8 years of age, was run over by a car and sustained an exposed tibial fracture and major soft-tissue injury of the foot. Anterior tibial, posterior tibial and extensor hallucis longus tendon rupture were detected. Damage control, soft-tissue cover and conservative treatment of the anterior tibial and extensor hallucis longus tendons were initially performed; however, the conservative treatment failed, and valgus deformity and pronation developed. Subsequently, tenoplasty (posterior tibial tendon), the Strayer procedure (gastrocnemius recession of the Achilles tendon) and elongation of the peroneus longus and brevis tendons were also performed, but the patient experienced deformity recurrence. Subcutaneous peroneus brevis tendon transfer to the navicular was then chosen, with postoperative use of an ankle-foot orthosis (AFO) and physical therapy. Results: The deformity was improved. The patient progressed with satisfactory gait and strength. He currently walks without support using an AFO. Both the patient and his family were satisfied with the functional outcome of the tendon transfer. Conclusion: Reconstruction of anterior tibial and extensor hallucis longus tendon rupture through peroneus brevis tendon transfer is a viable and reliable treatment option. No complications such as adhesions or correction failure were observed, thus corroborating the viability of this method.

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Transfer versus Lengthening of the Posterior Tibial Tendon in Duchenne's Muscular Dystrophy

Foot & Ankle ◽

10.1177/107110079201300907 ◽

1992 ◽

Vol 13 (9) ◽

pp. 526-531 ◽

Cited By ~ 6

Author(s):

Walter B. Greene

Keyword(s):

Muscular Dystrophy ◽

Tendon Transfer ◽

Perioperative Complications ◽

Operating Time ◽

Posterior Tibial Tendon ◽

Foot Deformity ◽

Posterior Tibial ◽

Duchenne's Muscular Dystrophy ◽

Shoe Wear

Transfer of the posterior tibialis tendon to the dorsum of the foot was compared with lengthening of this tendon in 15 patients with Duchenne's muscular dystrophy. Patients undergoing tendon transfer ( N = 9) had a longer operating time and two perioperative complications, but retained plantigrade posture of their feet even after walking ceased. By contrast, lengthening of the posterior tibialis tendon (A/ = 6) was associated with a recurrent equinovarus foot deformity that frequently interfered with shoe wear. Although transfer of the posterior tibialis is out of phase and technically more demanding, the unique prolongation of posterior tibialis strength in Duchenne's muscular dystrophy makes this operation a better option for these patients.

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Tendon Transfer Combined with Calcaneal Osteotomy for Treatment of Posterior Tibial Tendon Insufficiency: A Radiological Investigation

Foot & Ankle International ◽

10.1177/107110079501601108 ◽

1995 ◽

Vol 16 (11) ◽

pp. 712-718 ◽

Cited By ~ 196

Author(s):

Mark S. Myerson ◽

John Corrigan ◽

Francesca Thompson ◽

Lew C. Schon

Keyword(s):

Tendon Transfer ◽

Posterior Tibial Tendon ◽

Flexor Digitorum Longus ◽

First Metatarsal ◽

Posterior Tibial ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Before And After ◽

The Mean ◽

Flexor Digitorum

We present the radiographic results after flexor digitorum longus tendon transfer combined with a medial displacement calcaneal osteotomy for the treatment of posterior tibial tendon insufficiency. Eighteen patients with posterior tibial tendon insufficiency were reviewed from 12 to 26 months after surgery. The 15 women and 3 men had a mean age of 54 years (range, 38–72 years). The talar-first metatarsal and talonavicular coverage angles were measured before and after surgery on the anteroposterior weightbearing radiographs. The mean preoperative talar-first metatarsal and talonavicular coverage angles were 21° (range, 3–45°) and 34° (range, 0–55°), respectively. The mean postoperative values for these angles were 8.5° (range, 0–35°) and 21° (range, −30–45°), respectively. The mean talar-first metatarsal angle decreased from 21° to 8.5°, a mean improvement of 12.5°, and the mean talonavicular coverage angle decreased from 34° to 21°, a mean improvement of 13°. On the lateral weightbearing radiographs, the talar-first metatarsal angle and the distance from the medial cuneiform to the floor were measured before and after surgery. The mean preoperative values were −22° (range, −10 to −40°) and 9 mm (range, 1–19 mm), respectively. The mean postoperative values were −9° (range, +5 to −25°) and 16 mm (range, 10–28 mm), respectively. The mean talar-first metatarsal angle decreased from −22 to −9° (a mean improvement of 13°), and the distance from the medial cuneiform to the floor increased from 9 to 16 mm (a mean improvement of 7 mm). We conclude that the use of a combined medial displacement osteotomy of the calcaneus with a tendon transfer for treatment of posterior tibial tendon insufficiency may offset the inherent weakness of the flexor digitorum longus transfer by reducing the antagonistic deforming force of heel valgus.

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