Comparison of the Ponseti method versus early tibialis anterior tendon transfer for idiopathic clubfoot: A prospective randomized study

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.
Materials and 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 measure- ments 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 308 (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 158 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.