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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

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

1
Department of Paediatric Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
2
Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2016, 52(3), 163-170; https://doi.org/10.1016/j.medici.2016.04.004
Received: 8 March 2016 / Revised: 21 April 2016 / Accepted: 26 April 2016 / Published: 12 May 2016
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.
Keywords: Clubfoot; Ponseti method; Tibialis anterior tendon transfer; Functional radiological outcome Clubfoot; Ponseti method; Tibialis anterior tendon transfer; Functional radiological outcome
MDPI and ACS Style

Gintautienė, J.; Čekanauskas, E.; Barauskas, V.; Žalinkevičius, R. Comparison of the Ponseti method versus early tibialis anterior tendon transfer for idiopathic clubfoot: A prospective randomized study. Medicina 2016, 52, 163-170.

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