胫前肌腱转移复发性马蹄内翻足

                               
登录/注册后可看大图

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.

It has been reported that 7% to 56% of patients have a relapse of the deformity after initial treatment of idiopathic clubfoot with the Ponseti method of serial manipulations and casts. Relapse is identified by a dynamic supination deformity during walking and progressive heel varus malalignment. In a patient with a relapsed idiopathic clubfoot, the correction obtained by repeated manipulation and serial casts is effectively maintained by transfer of the entire tibialis anterior tendon to the mid-dorsum of the foot as originally described by Garceau in 1940 and later modified by Ponseti. This procedure is effectively performed in children between the ages of two and six years (the age range in which relapse typically occurs) and adequately corrects the muscle imbalance of the foot to prevent another relapse of deformity.

The entire tibialis anterior tendon is transferred from its native insertion on the medial cuneiform and first metatarsal to the lateral cuneiform through a two-incision approach. The inferior extensor retinaculum is typically left intact as the tendon is passed beneath it in order to prevent bowstringing. After preparation with a Bunnell-type stitch using nonabsorbable suture, the tendon is passed through an osseous tunnel drilled through the lateral cuneiform. The tendon is secured to the mid-dorsum of the foot by tying the suture over a foam square and plastic button on the plantar aspect of the foot. The foot should be held in dorsiflexion during tensioning and tying of the tendon into place. The tendon transfer is protected with a long leg cast for six weeks postoperatively.