Modified split tendon transfer of posterior tibialis muscle in the treatment of spastic equinovarus foot deformity: long-term results and comparison with the standard procedure

Int Orthop. 2020 Jan;44(1):155-160. doi: 10.1007/s00264-019-04443-6. Epub 2019 Nov 19.


Introduction: Split tendon transfer of tibialis posterior (SPOTT) is a treatment option for the hindfoot varus deformity in patients with cerebral palsy (CP). The purpose of this study was to present the long-term results of the newly modified SPOTT procedure developed by our senior author and compare it with the standard SPOTT technique in equinovarus foot deformity due to CP.

Method: Our retrospective cohort study included patients with spastic foot deformity due to CP treated with the standard or modified SPOTT technique. Patients' age at the time of the surgery was ≥ five years with follow-up period of at least four years. Surgical outcomes were evaluated using Kling's criteria during the patient's last follow-up visit.

Results: The analysis included 124 patients (146 feet), where 105 feet were treated by the standard SPOTT technique and 41 feet by the modified SPOTT technique. Patients' median age at the time of the surgery was 11 years. Patients were followed-up for a median period of eight years during which the modified SPOTT technique showed significantly better surgical outcomes compared with the standard group (excellent/good results in 38 feet, 92.7%, vs. 79 feet, 75.2%, p = 0.02). Two groups of patients did not significantly differ in GMFCS level, age at the time of the surgery, or patient gender. There was similar distribution in CP patterns in the standard and modified groups; spastic hemiplegia was the most prevalent form, followed by spastic diplegia and spastic paraplegia. Overall, better surgical success was achieved in patients with GMFCS levels I-III (100%, 94.8%, and 69.8%, respectively). SPOTT procedure failure was frequently noticed in patients with GMFCS level IV (90.9%).

Conclusion: The modified SPOTT procedure demonstrated efficiency and safety in patients with equinovarus foot deformity due to CP during the long-term follow-up. Compared with the standard procedure, the newly modified SPOTT technique showed significantly better surgical outcome, irrespective of the patients' gender, age, initial GMFCS level, and CP type.

Keywords: Cerebral palsy; Modified technique; Outcomes; Spastic equinovarus foot; Split posterior tibialis tendon transfer; Surgery.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Cerebral Palsy / complications*
  • Child
  • Clubfoot / etiology
  • Clubfoot / surgery*
  • Female
  • Follow-Up Studies
  • Hemiplegia / etiology
  • Humans
  • Male
  • Muscle Spasticity / surgery
  • Paralysis / etiology
  • Retrospective Studies
  • Tendon Transfer / methods*