ATTT Surgery for Clubfoot

(The anterior tibial tendon transfer)
The ATTT surgery for clubfoot, which stands for Anterior Tibial
Tendon Transfer and not a telephone company is one of the very few
clubfoot surgeries the Ponseti Method might entail under ordinary
circumstances.

My first born son, Brian, had the ATTT when he was two years old.

Why would the so-called "NON-surgical" method of clubfoot
treatment include an ATTT surgery?  

Because the Ponseti Method boasts a 97% non surgical rate - there
is that remaining 3% of the population who for whatever mysterious
reason, fails to respond to the method.  

There are also those many children who began their treatment with
non-Ponseti skilled doctors and ended up needing a more drastic
measure to complete their correction.  This was the case with my son
Brian.  By the time we discovered Dr. Ponseti, Dr. Ponseti could do
no more for him except this operation.


















The ATTT surgery is a procedure that is rather non-invasive as far
as clubfoot surgery goes.   A tendon at the top of the foot which
connects to the big toe is moved, i.e. "Transfered" to a new location,
preventing the foot from turning inward anymore.  The thumbnail
photo at the top of this page is showing Brian's foot the day his
post-op casts came off.  The button on bottom of his foot was actually
anchoring the tendon in place while the foot healed.  You will also
notice a red line on the top of his foot - there are two red lines,
actually - one where the tendon was taken off and another where it
was reattached.  

Admittedly I am not the best person to display the results of this
surgery since Brian's feet continue to hold a noticeable kidney shape
to them and no one can seem to explain to us why - however, with
that said, let me continue to say that once Brian had the ATTT
surgery for his clubfoot, he was finally able to walk normally, wear
shoes normally and most important to me: He was no longer in
constant foot pain.

The majority of children who have the ATTT surgery do not have
kidney shaped feet at the end of it.

Using the anterior tibial tendon transfer, no bones are cut, no
ligaments are cut, no pins are inserted - none of that damaging stuff
so common in traditional clubfoot surgeries that generally leads to
long term problems such as pain and stiffness in the foot years on
down the road.

If your child is suffering from a persistent relapsed condition, or if
your older toddler age child had treatment other than that of the
Ponseti Method, then you child may be a good candidate for the
ATTT surgery.   If any doctor wants to do surgery on your clubfooted
child, first of all seek a 2nd opinion from a true Ponseti Method doctor
(remember many doctors claim to use the method but  actually
do not!), and find out if the ATTT would be an alternative you should
consider.  

Keep in mind also that many children whom other doctors say need
surgery end up not needing surgery once their feet are corrected
with casts by an experienced Ponseti Method doctor.   Any good
Ponseti doctor worth his salt is going to exhaust all his casting
options before he ever suggests putting the baby through this
surgery or any other.  I also want to add that although your doctor is
a genuine Ponseti Method physician, those will less experience may
believe they have exhausted all their options when in fact they have
not....as a parent you have to really stay on top of all this for your
child.

Although not used a lot, the ATTT surgery for clubfoot  is a good last
resort for children generally around two or three years old who have
failed to maintain their correction through the foot abduction brace
system.

It is very rare (3% or less) for a child who is treated via the Ponseti
Method to require the ATTT surgery for clubfoot so in fact the
non-surgical Ponseti Method really is non-surgical for the
overwhelming majority of children who are born with the clubfoot
deformity.