Abstract
We evaluated 28 patients, 52 feet with flaccid paraparesis (27 MMC, 1 neonatal paraplegia) in which a posterior transference of the tibialis anterior was performed for talus deformities. Between 1987 and 2001 in two institutions.
Mean age at surgery 6+6 ( from 0+4 to 12+10) 16 males, 12 females,
Neurological last level functioning was 1 Toracic, 2 lower lumbar, 25 sacral
Technique: through minimal incisions the muscle is transferred posteriorly opening bluntly the interosseous membrane and weaved to the aquiles tendon if present and fixed to the top of the os calcis in 10° of equinus
There where 23 bilateral cases
Asociated surgeries 17 extension calcaneal osteotomies 5 peroneal z plasties, 4 short peroneal to posterior tibialis transfer, 2 vertcal talus correction, 2 Evans lenghtenings, 1 IF arthrodesis
Follow up in 25 patients (3 lost) was 3+11 (0+3 to 12+1)
Complications: 1 late calcaneal osteomielitis, ,2 severe valgus feet in a vertical talus
Results: we measured calcaneal pich in 26 feet in a lateral xray. Mean preop measure 34*(20 to 50 ) postp 21* (15 to 25).
All patients were independent walkers at follow up.
Conclusion: Posterior transfer of the tibialis anterior is an excellent operation that prevents talus progression in the absence of planta flexors alone or in conjuction with extension calcaneal osteotomy in older children, the better position lessens trhe chance for the habitual skin lesions in this patients
