Abstract
Purpose
This study aimed to objectively define gait derangements and changes before and after Tibialis Anterior Tendon Transfer surgery in a group of patients treated using the Ponseti method.
Methods
21 feet in 13 patients with Ponseti treated clubfoot who showed supination in swing on clinical examination, underwent gait analysis before, and approximately 12 months after, Tibialis Anterior Tendon transfer. 3–4 weekly casts were applied prior to the surgery, which was performed by transfer of the complete TA tendon to the lateral cuneiform. A parental satisfaction questionnaire was also completed.
Results
In all but one patient, increased supination in swing phase was confirmed on pre-operative gait analysis, with EMG evidence of poor Tibialis Anterior modulation through-out the gait cycle.
Post-operatively all patients showed improved positioning at initial contact, with heel strike and an absence of supination, and a decrease in swing phase supination.
In all patients, knees were overly flexed at initial contact, some continuing through stance phase; there was no change seen postoperatively.
All parents reported marked improvements in gait and activity level post-operatively.
Conclusion
Gait analysis can be useful to confirm the need for tibialis anterior tendon transfer. Improved post-operative gait patterns seen by parents and clinicians can be related to objective improvements seen during gait analysis, confirming the benefit of tibialis anterior tendon transfer in appropriate patients.
