Tibialis anterior tendon transfer is a surgical procedure commonly done to move the part of the tendon of the muscle tibialis anterior from its original position where it anchors into bone (the inner border of the foot) to the outer and top surface of the foot.
This is a treatment most commonly employed for recurrent clubfoot in order to get a plantigrade foot which means standing with the soles of the foot in complete contact with the ground.
In this article, we will go over some of the physiotherapy that you can do as a part of a recovery process following tibialis anterior tendon transfer.
Tendons are mostly avascular tissues. An avascular tissue is one that doesn’t get much, to no blood supply. Therefore due to their relatively avascular start, even their healing is relatively slower compared to areas that get an abundance of blood like muscles and skin.
Physiotherapy following tibialis anterior transfer often starts after 6 weeks though it could start later if your doctor isn’t convinced about the healing of the tendon. If it started too early, there is a risk of interfering with the healing of the tendon at the new insertion site.
Children often heal uneventfully without any significant deficits if no post-operative complications arise but mostly if both the patients and caretakers comply with the instructions given to them by the doctors.
physiotherapy plan based on the post-op week
Week 1 to 6
Following surgery, the foot will be in a cast not only to keep the foot in a desirable position but also to allow the tendon to heal in that position.
Tips;
- Keep the foot elevated in order to prevent excessive swelling of the foot.
- Wiggle your toes from time to time to prevent stiffness in the toes and to allow better blood flow through the foot.
- Do not walk on the cast until advised by your doctor as this will force different movements in the foot which could pull out the tendon.
- walk with the use of walking aids.
Week 6 to week 10
The cast will be removed at this point but you will have to continue in an ankle foot orthosis (AFO) which will still keep the foot in an acceptable position.
These are some of the exercises that may be important.
- Stretching and range of motion exercises
These will help increase the range of motion in the foot and the ankle joint
- Leg strengthening exercises
You will lose some muscle tone in your leg muscles during immobilization and this could present as weakness in the leg. Therefore, leg-strengthening exercises are vital in this recovery process.
The leg comprises three muscle compartments. The compartment that needs strengthening, in this case, is the front or anterior compartment. It is made up of 4 muscles.
These are primarily dorsiflexion of the foot at the ankle joint which allows your foot to face upwards.
Examples of strengthening exercises.
- Resistance band exercises
Using the resistance from an elastic band, attempt to dorsiflex and plantarflex only to the extent that is comfortable. This involves the upward and downward movement of the foot.
- Rock on your feet.
Stand up and then do a rocking movement back and forth. Do this 20 times and take a 10-second breather. Do 3 repetitions.
In conclusion, tibialis anterior tendon transfer is a well-known procedure used to achieve a plantigrade foot.
You will wear a cast following the surgery in order to allow the tendon to heal. Physiotherapy following tibialis anterior tendon transfer will then continue in an AFO while doing the foot and leg exercises.
