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This transfer is required in 10-20% of children who undergo the Ponseti treatment
12%
387/3196
Weak peroneals are counteracted by overpull of the anterior tibialis
6%
194/3196
Grade 4 or 5 strength of the anterior tibialis is needed prior to transfer
5%
174/3196
Subtalar rigidity supplements the transfer
72%
2286/3196
Dynamic supination includes foot supination during swing phase and landing on the lateral foot border during stance phase
4%
133/3196
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The patient has dynamic supination as a result of overpull of the anterior tibialis in relation to the peroneal tendons. During the Ponseti casting, cavus is corrected by aligning the first ray with the remaining metatarsals. Next, abduction of the forefoot using the lateral talar head as a fulcrum corrects the forefoot adduction and hindfoot varus deformities. At least Grade 4 strength is needed prior to transfer to ensure that dorsiflexion of the foot will be preserved. Subtalar rigidity is a contraindication to anterior tibial tendon transfer. The referenced book chapter and review article discuss the Ponseti method of clubfoot treatment and its sequelae.
4.2
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