Abstract
Purpose of the Study. Authors present transposition and hemitransposition of anterior tibial muscle as one of the supporting surgeries in the treatment of neurogenous but also congenital club foot.
Material. In the period of 30 years they indicated and performed transposition of anterior tibial muscle 79times in 75 patients and hemitransposition of anterior tibial muscle in 27 patients.
Most frequently they used this method in patients with childrens' cerebral palsy, least frequently in patients with congenital club foot. Methods.
The authors prefer hemitransposition of anterior tibial muscle (Biesalski-Mayer) at the younger age and transposition of the whole anterior tibial muscle in children above the age of 9 years and in cases where the foot is more rigid or where bone changes already have developed. From the medial approach they expose the distal origin of the tendon of anterior tibial muscle, separate one or both origins of the tendon in compliance with the nature of the transposition, transpose over a supporting section above the ankle and fix the tendon to base V or IV of the metatarsal.
The evaluated group included patients who at the given period attended the control check, i.e. 14 patients after hemitransposition and 45 patients after complete transposition. The shortest interval after the surgery was 9 months.
Results. In the evaluated group the authors performed clinical examination and radiograph.
They report excellent results in hemitransposition in 57,1% with achieved plantigrade position of the foot and the function of transposed muscle 4 according to the muscle test. In 42,9% of cases the result was good.
Similar results they recorded in complete transposition, excellent result in 23 cases (48,9%), good result in 8 patients (38,2%), in 2 patients there occured valgus overcorrection (4,3%), in 8,5% of patients with progressive disease the position subsequently worsened. Radiograph examination showed in the younger age group until the age of 8 years an increased value of the talocalcanear angle.
Discussion. By the number of patients, indication and results the evaluated group is comparable with literary data.
The authors present reasons for the localization of transposition to Vth or IVth metatarsal in contradiction to biomechanical studies. This operation is not usually indicated as a separate surgery, most often it is performed simultaneously with the operation on m. triceps surrae and operation after Steindler.
Conclusion. The method of transposition of anterior tibial muscle is recommended by authors mainly in neurogenous club foot where a combined operation on muscles may result in the final remedy of the defect.
The method of complete transposition of anterior tibial muscle may be used also in progressive neurogenous diseases with the purpose of postponing resection sub talo.