Tibialis Anterior to Peroneus Brevis Tendon Transfer: A Novel Technique for Dynamic Supination after Ponseti Treatment of Idiopathic Clubfoot.

Abstract

The study aims to determine the outcome of the new technique in terms of the correction rates in comparison to results reported in the literature for the standard procedure. A prospective study was conducted between September 2017 to August 2025 on 53 feet in 41 children who developed dynamic supination after a complete initial correction with the Ponseti technique. Preoperative and postoperative functional assessments were done independently by two senior orthopaedic consultants using standardized gait evaluation and the Laaveg-Ponseti functional score. Follow-up ranged from 20 to 61 months. Initial correction was achieved in 49 feet, whereas four feet demonstrated postoperative residual dynamic supination; out of these, three resolved with physiotherapy, whereas one foot required surgical intervention. Another four feet (7.5%) developed deformity recurrence later in follow-up; one corrected with physiotherapy, whereas three required surgical management. The final overall success rate of the procedure was 88.7% after excluding the resistant, recurrent, and overcorrected cases that needed surgical correction. Preoperative Laaveg-Ponseti scores improved markedly to exclusively good or excellent at the final follow-up (P < 0.001). Tibialis anterior transfer to the peroneus brevis can be performed in children, as it does not require lateral cuneiform ossification. This modification is a practical and effective alternative to the standard technique.