Transposition of the posterior tibial tendon

The posterior tibial tendon was rerouted by the technique described by Baker and Hill in 35 feet of children with a dynamic varus deformity due to spastic cerebral palsy. The average follow-up period was 11.4 years. In ten of the feet, rerouting of the posterior tibial tendon was the only procedure performed. Eight of the ten feet obtained a satisfactory correction. There were no overcorrection problems in these ten feet. In the remaining 25 feet, the Baker-Hill procedure was done concurrently with other procedures, such as lengthening of the triceps surae (22 feet), calcaneal osteotomy (two feet), or plantar fascia release (two feet). The dynamic equinovarus deformity was corrected in all 25, but three subsequently developed a cavus deformity. This was probably caused by excessive weakening of the triceps surae rather than transposition of the posterior tibial tendon. Based on this study, anterior rerouting of the posterior tibial tendon seems to be a simple, safe, and generally effective procedure for correction of dynamic varus of the spastic hindfoot in children with cerebral palsy.