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Newborn with forefoot adduction
0%
6/1927
3-year-old with a foot that supinates when he dorsiflexes
79%
1519/1927
6-month-old residual equinus after casting
6%
109/1927
5-year-old boy with a fixed hindfoot varus
8%
160/1927
2-year-old with a foot that pronates when he plantarflexes
118/1927
Select Answer to see Preferred Response
Transferring the anterior tibialis - or doing a split transfer - is appropriate for clubfoot patients who are found to have dynamic supination once ambulatory following Ponseti treatment. Club foot, congenital talipes equinovarus, can be thought of as having four deformities using the following mnemonic: C = Cavus midfoot A = Adducted forefoot V = Varus hindfoot E = Equinus The Ponseti method begins with correction of cavus by aligning the first ray with the remaining metatarsals. Subsequent manipulation and casting utilizes lateral pressure on the distal talar head as a fulcrum to correct the forefoot adduction and hindfoot varus. The last step is the correction of equinus which may require tendoachilles release in >90%. Subsequent dynamic forefoot adduction/supination requires transfer of the anterior tibialis laterally in 15-20% of patients. Osteotomies should be considered in rigid deformities. Laaveg and Ponseti published their long-term results in 1967 showing effectiveness of tibialis anterior tendon transfer to the 3rd cuneiform as helpful for eliminating recurrent cavus deformies and straightening the foot during ambulation. Dobbs et. al wrote a review with Ponseti of his methods in the Iowa Orthopaedic Journal discussing their treatment of clubfoot. Optimal timing of tibialis anterior transfers is between 2.5-3 years of age, which the muscle becomes a powerful supinator. Incorrect Answers: 1. Forefoot adduction in newborns has many causes, most common of which is metatarsus adductus which usually corrects without intervention 3. The 6-month-old with residual equinus after casting should undergo a tenoachilles lengthening 4. Fixed deformities usually require osteotomies for correction 5. The tibialis anterior is a dorsiflexor and supinator
4.1
(24)
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