Clubfoot posteromedial release: advantages of tibialis anterior tendon lengthening

Abstract

The aim of this study is to evaluate the eventual advantages of tibialis anterior (TA) tendon lengthening during clubfoot posteromedial release. A continuous series of 60 idiopathic clubfeet has been retrospectively studied. Tibialis anterior lengthening (TAL) began to be performed in 1984. Two groups of 30 feet have been distinguished: without TAL (before 1984) and with TAL (after 1984). There was no significant difference between the 2 groups concerning mean age at surgery, preoperative clinical and radiologic data. Mean postoperative follow-up was 10 years and minimal follow-up required was 5 years. TAL decreased Triceps surae relative insufficiency and improved monopodal jump. TAL balanced TA and peroneus longus, decreased dynamic supination and balanced forefoot pronation and supination. The feet without TAL presented lack of anteromedial support (20% without TAL, 0% with TAL) and medial arch cavus with dorsal talo-navicular subluxation (20% without TAL, 3,3% with TAL). TAL decreased the rate of recurrence and surgical revision.