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While treatment of children born with clubfoot nowadays often follows well-described non-operative approaches, relapse is not uncommon following initial correction. In children older than 2.5 years, a recommended surgical approach is to transfer the anterior tibialis tendon (ATTT) laterally to the third cuneiform, third/fourth metatarsal or to the cuboid. The use of pedography has become quite common to test plantar pressures in children with clubfoot. However limited work has been done to assess functional outcome following ATTT.

Using novel’s emed^® technology, the group of researchers around Kelly Jeans from Dallas, Texas, embarked on a study to objectively test whether plantar pressures normalize after ATTT. Between 2003 and 2010, thirty children with clubfoot (37 clubfeet) underwent gait analysis and plantar pressure tests, which implied walking on the emed^® platform for a minimum of five trials for each foot both preoperatively and postoperatively, i.e. one to two years after the surgery. Contact area, contact time, and peak pressures were quantified for seven different regions of the foot. The researchers found significant differences between preoperative and postoperative outcomes. The changes after ATTT, as they conclude, show that “the foot is better aligned for a more even distribution of pressure throughout the foot, but is not fully normalized”.

Jeans, K; Tulchin-Francis, K.; Crawford, L. and L.A. Karol 2014:
Plantar pressures following anterior tibialis tendon transfers in children with clubfoot.
Journal of Pediatric Orthopaedics 34 (5): 552-558