title: Comparison of the Ponseti method versus early tibialis anterior tendon transfer for idiopathic clubfoot: A prospective randomized study.
abstract: OBJECTIVE
  The aim of the study was to compare functional and radiological outcomes in clubfoot patients treated by early Tibialis anterior tendon transfer and Ponseti method.
  
  
  METHODS
  A prospective, randomized study was conducted. A total of 39 children with a mean age of 17.05 days (55 clubfeet) were randomly allocated into one of two groups: first (conservative Ponseti method) group (n=28) or second (early tibialis anterior tendon transfer [TATT]) group (n=27). Foot function and radiographic measurements were evaluated. The condition of the subjects was observed until they reached the age of 2 years.
  
  
  RESULTS
  The clinical and radiological data did not differ between groups at the age of 6 months. No statistically significant difference regarding Pirani and Dimeglio scale among the groups was observed at the last follow-up. A statistically significant difference was observed in the foot dorsal flexion; it was lower in the second group (P=0.03). Other clinical parameters did not differ between groups. According radiographic data, only the talocalcaneal angle (TCA) was significantly higher in the second group (P=0.003). Children who underwent TATT were 5.00-fold (P=0.002) and 1.67-fold (P=0.017) more likely to have TCA larger than 30° (which reflects the normal range of the TCA) in DP and lateral views, respectively, and 3.40-fold (P=0.019) more likely to have foot dorsal flexion of less than 15° than their counterparts undergoing the conservative Ponseti treatment.
  
  
  CONCLUSIONS
  Early TATT allowed a significant reduction in the brace wear duration and resulted in the same outcomes as using the Ponseti method. Additionally, TATT can provide some improvement of hindfoot varus. However, a possible weakening of dorsiflexion should be also taken into account. Our experience has shown the need for a larger sample and longer term studies.
authors: Department of Paediatric Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: jolitagint@gmail.com.
authors: Jolita
authors: J
authors: Gintautienė
authors: Department of Paediatric Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors: Emilis
authors: E
authors: Čekanauskas
authors: Department of Paediatric Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors: Vidmantas
authors: V
authors: Barauskas
authors: Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors: Rimantas
authors: R
authors: Žalinkevičius
mesh_terms: D001915:Braces; D002675:Child, Preschool; D003025:Clubfoot / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization / Q000379:methods; D007223:Infant; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012008:Recurrence; D018709:Statistics, Nonparametric; D013709:Tendon Transfer / Q000379:methods*; D058971:Tenotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Clubfoot; Functional radiological outcome; Ponseti method; Tibialis anterior tendon transfer