Presentation
Previous club foot. Pain around then ankle.
There is mild hindfoot valgus bilaterally, but alignment is near-normal. There are lucencies projected over the lateral cuneiforms bilaterally consistent with a previous tibialis anterior tendon transfer for the treatment of club foot.
Annotated images of the right foot with the medial, intermediate and lateral cuneiforms and the insertion point of the tibialis anterior tendon in the lateral cuneiform.
The MRI sequences demonstrate normal tibialis anterior muscles in both anterior compartments. Rather than being inserted into the medial aspect of the medial cuneiform, they deviate laterally at the ankle and are inserted through the lateral cuneiform. Features here are of an anterior tibialis tendon transfer.
There is abnormal high signal in the distal tendon of the left tibialis anterior muscle.
Case Discussion
There are a number of non-operative and operative management plans for patients with CTEV (club foot). One operative management plan includes transfer of the tendon insertion point on tibialis anterior from the medial surface of the medial cuneiform to the lateral cuneiform, resulting in a reduction in the degree of equinus and eversion.
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