Letter Regarding: Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy

Dear Editor,

Equinovarus deformity is a common foot deformity that occurs in cerebral palsy which is due to a dynamic imbalance between the invertors and evertors leading gradually to a more fixed deformity. We read with interest the study by Bacaksız et al ¹ on the role of calcaneocuboid fusion (CCF) along with split tibialis anterior tendon transfer (STATT) in such children. The authors concluded that addition of CCF to a STATT procedure generally resulted in better functional outcomes in comparison to isolated STATT procedure in a spastic equinovarus foot.

The authors have postulated a novel concept of calcaneocuboid instability in such children. Although possible theoretically in long-standing cases, the literature lacks any objective study nor does any cadaveric study exist to back this concept. Although etiologically different, this concept has been explored in nonspastic pathologies like clubfoot. ⁴ The study terms the relationship between calcaneum and cuboid as “malalignment” rather than “instability.” Rather than CCF, this requires a release of the calcaneocuboid joint. ⁴ Dynamic assessment methods such as ultrasonography may be used to document the pathology. ² Cadaveric and finite element studies would also help in noting and confirming the mentioned instability at the joint.

This study, which is retrospective in nature, does not shed light on the selection criteria for CCF in such children. It would be helpful to gain insight into the factors that should be considered before proceeding on a CCF. As such, fusion of any joint in the foot has a cascading effect on the dynamics of the neighboring joint; this procedure should be considered after careful evaluation. The short follow-up period in the study may not be able to provide information regarding the long-term effects of CCF.

Isolated SPATT for equinovarus deformity in children with cerebral palsy has been one of the widely accepted procedure with predictable outcomes as well as failure rates.^3,5 The role of CCF in such children may be widely accepted provided this concept is proven objectively either through dynamic evaluation, cadaveric, or finite element studies.

Supplemental Material

sj-pdf-1-fai-10.1177_10711007231213366 – Supplemental material for Letter Regarding: Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy

Supplemental material, sj-pdf-1-fai-10.1177_10711007231213366 for Letter Regarding: Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy by Sitanshu Barik, Vishal Kumar and Vikash Raj in Foot & Ankle International

Sitanshu Barik, MCh Vishal Kumar, MS Vikash Raj, MS All India Institute of Medical Sciences, Deoghar, India [e-mail]