Evaluation of Tendon-to-Tendon Versus Tendon-to-Bone Transfers in Charcot-Marie-Tooth Foot Surgery

M Shaath, E McCarthy, G Van Eetvelde, M Chatoo, S Patel, N Cullen, K Malhotra, M Welck

Background: Charcot-Marie-Tooth (CMT) commonly presents with cavovarus foot deformities. Surgical correction involves bony correction and tendon transfer, usually of the tibialis posterior. Transfer methods include tendon-to-tendon or tendon-to-bone fixation. Although differences between these techniques have been evaluated for footdrop, no previous studies specifically analyse surgery for CMT. Our aim was to compare subjective outcomes and
complications between these techniques in CMT feet.

Methods: This was a single-centre retrospective series over 10-years. We included patients with CMT undergoing cavovarus foot correction with the following conditions: all had a calcaneal osteotomy, and tibialis posterior tendon transfer. We excluded patients under 18-years and those who had previous surgery. Subjective assessment was done using a questionnaire based on the Stanmore score and using the MOxFQ.

Results: 42 feet were included with mean 60-month (12-134-months) follow-up. 31 had tendon-to-bone transfers and 11 had tendon-to-tendon. MOxFQ significantly improved in both groups, but there was no difference in improvement (p>0.05). Patients in their 30s had greater improvement in MOx-FQ-Walking than older patients regardless of procedure (p=0.002). The only subjective differences noted between groups were tendon-to-tendon transfer had better balance (p=0.037), whilst tendon-to-bone required less orthotics (p=0.027). There was no overall significant difference in subjective improvements in power or range-of-movement between groups, or in complications or recurrence rates (p>0.05).

Conclusions: We did not demonstrate clinically meaningful differences in outcome between transferring the tibialis posterior to tendon or bone in CMT cavovarus foot correction. Choice of fixation can therefore be at the surgeon’s discretion, guided by patient-specific factors.