What is the best procedure for dorsiflexed/inverted foot type due to overpowering of the anterior tibial tendon?

What is the best procedure for dorsiflexed/inverted foot type due to overpowering of the anterior tibial tendon?

• A. Calcaneal osteotomy
• B. Split transfer of TA to cuneiforms
• C. Posterior Tibial Tendon Transfer
• D. Lateral ligament reconstruction

Answer: (B)

The key idea is rebalancing the forefoot by changing the pull of the tibialis anterior. When the tibialis anterior dominates, its action tends to dorsiflex and invert the forefoot, creating a dynamic dorsiflexed/inverted foot type. The most effective way to counter this is to alter the tendon’s line of pull by splitting the TA and transferring part of it to the medial cuneiforms. This re-routing reduces the inversion and dorsiflexion moment generated by the tendon, helping to normalize forefoot position while preserving some tendon function. Other procedures address different problems: a posterior tibial tendon transfer targets a pes planovalgus/PTTD pattern rather than overpowering TA, a calcaneal osteotomy realigns the hindfoot rather than correcting a dynamic TA-driven forefoot deformity, and lateral ligament reconstruction treats ankle instability rather than tendon-driven forefoot alignment.

The key idea is rebalancing the forefoot by changing the pull of the tibialis anterior. When the tibialis anterior dominates, its action tends to dorsiflex and invert the forefoot, creating a dynamic dorsiflexed/inverted foot type. The most effective way to counter this is to alter the tendon’s line of pull by splitting the TA and transferring part of it to the medial cuneiforms. This re-routing reduces the inversion and dorsiflexion moment generated by the tendon, helping to normalize forefoot position while preserving some tendon function.

Other procedures address different problems: a posterior tibial tendon transfer targets a pes planovalgus/PTTD pattern rather than overpowering TA, a calcaneal osteotomy realigns the hindfoot rather than correcting a dynamic TA-driven forefoot deformity, and lateral ligament reconstruction treats ankle instability rather than tendon-driven forefoot alignment.