ATTT: Anterior Tibial Tendon Transfer
(this page is currently under construction)
This procedure is commonly used to address relapses in older children. The University of Iowa has had excellent
long-term results by using this approach.
Here is a brief description from Dr. Ponseti's website:
"Relapses are common in severe clubfeet and are probably caused
by the same pathology that initiated the deformity, but they may easily be corrected by manipulation and two to three plaster
casts. When a second relapse occurs and the tibialis anterior muscle has a strong supinatory action, the tendon must be transferred
to the third cuneiform. This transfer prevents further relapse and corrects the anteroposterior talcocalcaneal angle, thereby
greatly reducing the need for tarsal release [9, 10]. "
Here are some links to information about the procedure:
(Ponseti method prescribes full-tendon transfer not split-tendon transfer)
Download second pdf file of Martin Egbert's compiled Ponseti medical studies on this site's
medical journals and papers page to read the 1980 paper (abstract below) by Laaveg and Ponseti regarding long term outcomes (addresses ATTT).
Long-term results of treatment of congenital club foot
and IV Ponseti
In seventy patients with
104 club feet that were treated at our hospital and followed for ten to twenty-seven years after treatment, the
functional results were satisfactory according to our rating system in 88.5 per cent of the feet, and
90 per cent of the patients were satisfied with both the appearance and function of the club foot. However, in
the majority of the patients, foot and ankle motion was limited and the talocalcaneal angles as seen
on the anteroposterior and lateral roentgenograms were not fully corrected. The amount of motion in the joints
of the foot and ankle and the correction of the lateral talocalcaneal angle correlated with the degree of
patient satisfaction and the functional rating of the club foot. Transfer of the anterior tibial tendon to
the third cuneiform appeared to prevent relapse.