Alternative Methods of Fixation for Anterior Tibialis Transfer in Residual Clubfoot Deformity

(1)Anterior tibialis transfer (ATT) is a commonly utilized method of addressing residual deformity following the Ponseti method(2)The classic fixation method includes using an absorbable suture tied over felt and a plantar button under the cast. While uncommon, this method can lead to significant pressure sores.(3)For patients who undergo isolated ATT, we now tie the button on the outside of the cast to avoid a pressure sore.(4)In patients who undergo ATT with additional treatment of posterior contracture, one can secure the anterior tibialis into the recipient site by tying it to a K-wire used to maintain the hindfoot correction.