Plantar pressures following anterior tibialis tendon transfers in children with clubfoot

Kelly A. Jeans, Kirsten Tulchin-Francis, Lindsay Crawford, Lori A. Karol

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Relapses following nonoperative treatment for clubfoot occur in 29% to 37% of feet after initial correction. One common gait abnormality is supination and inversion of the foot caused by an imbalance of the anterior tibialis tendon muscle. The purpose of this study was to determine if plantar pressures are normalized following an anterior tibialis tendon transfer (ATTT). Methods: Thirty children (37 clubfeet) who underwent an ATTT, were seen for plantar pressure testing preoperatively and postoperatively. Each foot was subdivided into 7 regions: medial/lateral hindfoot and midfoot, and the forefoot (first, second, and third to fifth metatarsal heads). Variables included: contact time as a percentage of stance time (CT%), contact area as a percentage of the total foot (CA%), peak pressure (PP), hindfoot-forefoot angle (H-F), location of initial contact, and deviation of the center-of-pressure line (COP). Paired t tests were used for group comparisons, whereas multiple comparisons were assessed with ANOVA (α set to 0.05 with Bonferroni correction). Results: Significant changes were seen in preoperative to postoperative comparison. PP, CT%, and CA% had significant increases in the medial hindfoot, midfoot, and first metatarsal regions, whereas the involvement of the lateral midfoot and forefoot were reduced. Compared with controls, postoperative results following ATTT continue to show increased PP, CA%, and CT% in the lateral midfoot, increased CA% and CT% in the lateral forefoot, whereas CA% was decreased in the first metatarsal region. Compared with controls, the COP line continues to move laterally and the H-F angle continues to show forefoot adductus following ATTT. No differences were found between patients treated with an isolated ATTT and those treated with concomitant procedures. Conclusions: The changes seen in plantar pressures following ATTT would suggest that the foot is better aligned for a more even distribution of pressure throughout the foot, but is not fully normalized. Level of evidence: Therapeutic level II.

Original languageEnglish (US)
Pages (from-to)552-558
Number of pages7
JournalJournal of Pediatric Orthopaedics
Volume34
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Tendon Transfer
Clubfoot
Pressure
Foot
Metatarsal Bones
Supination
Gait
Tendons
Analysis of Variance
Recurrence
Muscles

Keywords

  • Anterior tibialis tendon transfer
  • Children
  • Clubfoot
  • Gait
  • Plantar pressures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Plantar pressures following anterior tibialis tendon transfers in children with clubfoot. / Jeans, Kelly A.; Tulchin-Francis, Kirsten; Crawford, Lindsay; Karol, Lori A.

In: Journal of Pediatric Orthopaedics, Vol. 34, No. 5, 2014, p. 552-558.

Research output: Contribution to journalArticle

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abstract = "Background: Relapses following nonoperative treatment for clubfoot occur in 29{\%} to 37{\%} of feet after initial correction. One common gait abnormality is supination and inversion of the foot caused by an imbalance of the anterior tibialis tendon muscle. The purpose of this study was to determine if plantar pressures are normalized following an anterior tibialis tendon transfer (ATTT). Methods: Thirty children (37 clubfeet) who underwent an ATTT, were seen for plantar pressure testing preoperatively and postoperatively. Each foot was subdivided into 7 regions: medial/lateral hindfoot and midfoot, and the forefoot (first, second, and third to fifth metatarsal heads). Variables included: contact time as a percentage of stance time (CT{\%}), contact area as a percentage of the total foot (CA{\%}), peak pressure (PP), hindfoot-forefoot angle (H-F), location of initial contact, and deviation of the center-of-pressure line (COP). Paired t tests were used for group comparisons, whereas multiple comparisons were assessed with ANOVA (α set to 0.05 with Bonferroni correction). Results: Significant changes were seen in preoperative to postoperative comparison. PP, CT{\%}, and CA{\%} had significant increases in the medial hindfoot, midfoot, and first metatarsal regions, whereas the involvement of the lateral midfoot and forefoot were reduced. Compared with controls, postoperative results following ATTT continue to show increased PP, CA{\%}, and CT{\%} in the lateral midfoot, increased CA{\%} and CT{\%} in the lateral forefoot, whereas CA{\%} was decreased in the first metatarsal region. Compared with controls, the COP line continues to move laterally and the H-F angle continues to show forefoot adductus following ATTT. No differences were found between patients treated with an isolated ATTT and those treated with concomitant procedures. Conclusions: The changes seen in plantar pressures following ATTT would suggest that the foot is better aligned for a more even distribution of pressure throughout the foot, but is not fully normalized. Level of evidence: Therapeutic level II.",
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