Tibialis Anterior Tendon Transfer in an Arthrogrypotic Clubfoot

Case: A 30-month-old boy with arthrogryposis multiplex congenita presented with severe, recurrent teratological clubfoot refractory to serial casting, Achilles tenotomy, and plantar fascia release. Because of repeated cast slippage and patient distress, comprehensive posterior, plantar, and medial releases were performed, with cast exchange 2 weeks thereafter. A robust, taut tibialis anterior prompted addition of tibialis anterior tendon transfer to the lateral cuneiform. Postoperatively, plantigrade alignment was achieved both clinically and radiographically and maintained at the 2-year follow-up. Conclusion: Transfer of the tibialis anterior tendon after comprehensive correction may reduce recurrence by converting a deforming force into a corrective one during rapid growth in arthrogrypotic clubfoot.