Tibialis Anterior to Peroneus Brevis Tendon Transfer: A Novel Technique for Dynamic Supination after Ponseti Treatment of Idiopathic Clubfoot.

OBJECTIVE: The study aims to determine the outcome of the new technique in terms of the correction rates in comparison to results reported in the literature for the standard procedure.

METHODS: A prospective study was conducted between September 2017 to August 2025 on 53 feet in 41 children who developed dynamic supination after a complete initial correction with the Ponseti technique. Preoperative and postoperative functional assessments were done independently by two senior orthopaedic consultants using standardized gait evaluation and the Laaveg-Ponseti functional score. Follow-up ranged from 20 to 61 months.

RESULTS: Initial correction was achieved in 49 feet, whereas four feet demonstrated postoperative residual dynamic supination; out of these, three resolved with physiotherapy, whereas one foot required surgical intervention. Another four feet (7.5%) developed deformity recurrence later in follow-up; one corrected with physiotherapy, whereas three required surgical management. The final overall success rate of the procedure was 88.7% after excluding the resistant, recurrent, and overcorrected cases that needed surgical correction. Preoperative Laaveg-Ponseti scores improved markedly to exclusively good or excellent at the final follow-up (P < 0.001).

CONCLUSION: Tibialis anterior transfer to the peroneus brevis can be performed in children, as it does not require lateral cuneiform ossification. This modification is a practical and effective alternative to the standard technique.