Tibialis Anterior Tendon Transfer for Residual Dynamic Supination in Treated Clubfoot

Abstract

Clubfoot is a complex congenital deformity of the foot that may significantly impair mobility and functional activity if inadequately treated. Although the Ponseti method has become the standard treatment for idiopathic clubfoot and achieves satisfactory correction in most patients, residual or recurrent deformities may still develop during follow-up. Dynamic supination is one of the most frequent residual deformities after clubfoot treatment and is typically observed during the swing phase of gait, with the forefoot turning inward and initial contact occurring along the lateral border of the foot. The main etiology of residual dynamic supination is an imbalance between the relatively strong tibialis anterior muscle and its weaker antagonists, particularly the peroneal muscles. Persistent dynamic supination may result in abnormal gait patterns, progressive deformity, functional limitations, and difficulty with footwear. Tibialis anterior tendon transfer is a commonly used surgical procedure designed to restore muscular balance by redirecting the force of the tibialis anterior tendon toward the dorsum of the foot. The procedure aims to correct dynamic supination while preserving ankle dorsiflexion and improving overall foot alignment. Appropriate patient selection, correction of fixed deformities before surgery, accurate tendon positioning, and postoperative rehabilitation are essential for achieving satisfactory clinical and functional outcomes.