Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot
Background: The Ponseti method has revolutionized the treatment of idiopathic clubfoot, but recurrence remains problematic. Dynamic supination is a common cause of recurrence, and the standard treatment is tibialis anterior tendon transfer using an external button. Although safe and effective, the p...
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Series: | Foot & Ankle Orthopaedics |
Online Access: | https://doi.org/10.1177/2473011420923591 |
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doaj-3f60b74ea30e47a7a6b65a2a565c0bf62020-11-25T03:36:02ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142020-05-01510.1177/2473011420923591Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual ClubfootChanseok Rhee MD0Bernard Burgesson MD1Ben Orlik MD, FRCSC2Karl Logan MBChB, FRCS3 Department of Orthopaedic Surgery, Juravinski Hospital, Hamilton, Ontario, Canada Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada Department of Surgery, Division of Paediatric Orthopaedic Surgery, Nova Scotia, Canada Department of Surgery, Division of Paediatric Orthopaedic Surgery, Nova Scotia, CanadaBackground: The Ponseti method has revolutionized the treatment of idiopathic clubfoot, but recurrence remains problematic. Dynamic supination is a common cause of recurrence, and the standard treatment is tibialis anterior tendon transfer using an external button. Although safe and effective, the placement of the button on the sole creates a pressure point, which can lead to skin ulceration. In our institution, a suture button has been used for the tibialis anterior tendon transfer and we report our results here. Methods: Two senior authors’ case logs were retrospectively reviewed to identify 23 patients (34 feet) for tibialis anterior tendon transfer using a suture button. Complications and additional operative procedures were assessed by reviewing operative notes, follow-up visit clinic notes, and radiographs. The mean age of the patients was 6 years 2 months (SD 40 months) and the average follow-up duration was 67.1 weeks (SD 72 weeks). Results: There were 5 complications (14.7%). Recurrence occurred bilaterally in 1 patient (5.9%) but did not require reoperation. Other complications included a cast-related pressure sore (2.9%) and an infection (2.9%) requiring irrigation with debridement along with hardware removal. Conclusions: Tibialis anterior tendon transfer using a suture button was a safe procedure with theoretical advantage of providing stronger fixation and reducing the risk of skin pressure necrosis compared to the standard external button technique. We believe a suture button could allow earlier rehabilitation and may afford stronger ankle eversion. Prospective studies are required to compare the differences in functional outcomes between the procedures. Level of Evidence: Level IV, case series, therapeutic study.https://doi.org/10.1177/2473011420923591 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chanseok Rhee MD Bernard Burgesson MD Ben Orlik MD, FRCSC Karl Logan MBChB, FRCS |
spellingShingle |
Chanseok Rhee MD Bernard Burgesson MD Ben Orlik MD, FRCSC Karl Logan MBChB, FRCS Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot Foot & Ankle Orthopaedics |
author_facet |
Chanseok Rhee MD Bernard Burgesson MD Ben Orlik MD, FRCSC Karl Logan MBChB, FRCS |
author_sort |
Chanseok Rhee MD |
title |
Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot |
title_short |
Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot |
title_full |
Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot |
title_fullStr |
Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot |
title_full_unstemmed |
Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot |
title_sort |
suture button technique for tibialis anterior tendon transfer for the treatment of residual clubfoot |
publisher |
SAGE Publishing |
series |
Foot & Ankle Orthopaedics |
issn |
2473-0114 |
publishDate |
2020-05-01 |
description |
Background: The Ponseti method has revolutionized the treatment of idiopathic clubfoot, but recurrence remains problematic. Dynamic supination is a common cause of recurrence, and the standard treatment is tibialis anterior tendon transfer using an external button. Although safe and effective, the placement of the button on the sole creates a pressure point, which can lead to skin ulceration. In our institution, a suture button has been used for the tibialis anterior tendon transfer and we report our results here. Methods: Two senior authors’ case logs were retrospectively reviewed to identify 23 patients (34 feet) for tibialis anterior tendon transfer using a suture button. Complications and additional operative procedures were assessed by reviewing operative notes, follow-up visit clinic notes, and radiographs. The mean age of the patients was 6 years 2 months (SD 40 months) and the average follow-up duration was 67.1 weeks (SD 72 weeks). Results: There were 5 complications (14.7%). Recurrence occurred bilaterally in 1 patient (5.9%) but did not require reoperation. Other complications included a cast-related pressure sore (2.9%) and an infection (2.9%) requiring irrigation with debridement along with hardware removal. Conclusions: Tibialis anterior tendon transfer using a suture button was a safe procedure with theoretical advantage of providing stronger fixation and reducing the risk of skin pressure necrosis compared to the standard external button technique. We believe a suture button could allow earlier rehabilitation and may afford stronger ankle eversion. Prospective studies are required to compare the differences in functional outcomes between the procedures. Level of Evidence: Level IV, case series, therapeutic study. |
url |
https://doi.org/10.1177/2473011420923591 |
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