Tibialis Anterior Tendon Transfer for Relapsing Idiopathic Clubfoot.

[Introduction][1] 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][2] Ensure that the foot has been adequately corrected for tendon transfer by performing both clinical and radiographic evaluation. [Step 2: Prepare the Patient][3] 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][4] 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][5] 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][6] Identify the lateral cuneiform with fluoroscopy and prepare it for transfer of the tibialis anterior tendon. [Step 6: Transfer and Secure the Tendon][7] Make a subcutaneous path, transfer the tendon, and secure it in the osseous tunnel of the lateral cuneiform. [Step 7: Postoperative Care][8] We apply a long leg cast and restrict patients to non-weight-bearing for six weeks. [Results][9] The tibialis anterior tendon transfer has been used to treat relapsing idiopathic clubfoot with great success for more than fifty years. [Indications][10] [Contraindications][11] [Pitfalls & Challenges][12] [Introduction][1] 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][2] Ensure that the foot has been adequately corrected for tendon transfer by performing both clinical and radiographic evaluation. [Step 2: Prepare the Patient][3] 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][4] 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][5] 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][6] Identify the lateral cuneiform with fluoroscopy and prepare it for transfer of the tibialis anterior tendon. [Step 6: Transfer and Secure the Tendon][7] Make a subcutaneous path, transfer the tendon, and secure it in the osseous tunnel of the lateral cuneiform. [Step 7: Postoperative Care][8] We apply a long leg cast and restrict patients to non-weight-bearing for six weeks. [Results][9] The tibialis anterior tendon transfer has been used to treat relapsing idiopathic clubfoot with great success for more than fifty years. [Indications][10] [Contraindications][11] [Pitfalls & Challenges][12] [1]: #sec-11 [2]: #sec-12 [3]: #sec-13 [4]: #sec-14 [5]: #sec-15 [6]: #sec-16 [7]: #sec-17 [8]: #sec-18 [9]: #sec-19 [10]: #sec-21 [11]: #sec-22 [12]: #sec-23