Tibialis Posterior Tendon Transfer in Pediatric Para-lytic Varus Deformities

Background/Objectives: Transfer of the posterior tibialis tendon is a frequent procedure, primarily indicated for drop foot. Equinovarus deformities often stem from posterior tibialis spasticity or retrac-tion. While lengthening procedures are often used, they may be insufficient, leading to recurrence and further muscle weakness. Tendon transfer offers an alternative, aiming to correct hindfoot deformity and enhance stability during stance. This study assesses the procedure’s effectiveness in improving gait muscle balance, while also clarifying its indications. Methods: A retrospective study was con-ducted between 2007 and 2022 in the pediatric department of the Kassab Orthopedic Institute. The study included only walking patients with paralytic deformities exhibiting flexible varus hindfoot. All children underwent the same procedure. Evaluation, both static and dynamic, was performed us-ing clinical examination, video recordings, and Kling’s classification. Results: Twenty six children were included in the study. The average age at time of surgery was 11 years. After an average fol-low-up of 31 months, 93% patients were satisfied with 79% excellent results. Four feet (14%) showed good outcomes, maintaining less than 5°. Two feet (7%) had poor outcomes. Achieving better func-tional outcomes was significantly associated with preoperative muscle strength greater than 3/5. Skin complications were observed in 10% of cases. Conclusions: PTTT is an effective procedure correcting the imbalance between foot muscles even in spastic deformities. Flexible varus is essential for indica-tion and at least 3/5 grade muscle’s strength is mandatory for good outcome. Dynamic evaluation us-ing video records could be helpful for indication if instrumented gait analysis is not available.