Your child has been offered a Tibialis Anterior Tendon Transfer operation.
Sometimes a clubfoot corrects really well but some of the muscles on the outside of the foot are a bit weak. This can cause the foot to turn in and can sometimes cause tripping.
If this is the case then a Tibialis Anterior Tendon Transfer (TATT) operation can help. This is a simple operation to move a tendon in the foot to rebalance the muscle pull about the foot. It takes place under a general anaesthetic and is usually a day case procedure.
Sometimes an overnight stay will be required. Afterwards your child will need to be in a plaster cast for 6 weeks but they will be able to walk on the cast, and go to school. After the cast is removed at 6 weeks your child should get back to walking fairly quickly, but we will organise some physiotherapy to help the muscle get used to working in its new position. We also like your child to wear a night splint afterwards to keep the calf muscle stretched when they are asleep. This helps to keep the tendon transfer working nicely.
Before your child’s operation, we usually do some serial casting, applying a cast each week usually for 2-3 weeks. This helps to improve the position of the foot and ankle as much as possible before surgery. The exact number of casts will depend on individual assessment of your child. The cast may be applied to include the lower leg and may extend above the knee if clinically necessary.
Your child will be provided with a plaster shoe and will be able to walk on the cast. Inside the home, you can provide your child with a non-slip sock to wear over the cast. You may want to purchase some waterproof cast covers so that your child can have a shower or bath.
www.limboproducts.co.uk
Email: info@limboproducts.co.uk
Tel: 01243 573 417
Your child will be assessed by the pre-operative nursing team. This may be over the phone or in person in the Children’s outpatients department.
They will take some basic details of your child’s medical history and make sure that if there is anything significant that might affect the anaesthetic, all necessary investigations have been performed and we have all the information that we need to keep your child safe.
You will be given pre-operative instructions about when to come to the hospital and when to stop eating. This is important to ensure that at the time of the anaesthetic there is nothing in your child’s stomach.
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On the day of the surgery your child will be admitted to Coxen Ward, our paediatric ward on the 1st Floor of the Stanmore building. When you arrive you and your child will be shown to their bed space. One parent (or
carer) will be able to stay at all times. Soon after, Miss Tennant and her surgical team will visit you to go through the surgery again and get you to sign the consent form if this has not yet been done. You will also meet the anaesthetist who will check that your child is fit and well, tell you about the anaesthetic and check whether there are any wobbly teeth.
When your child goes down to the operating theatre, one parent or carer will be able to go as well, and stay until your child goes to sleep. You will then go back to the ward to wait for your child. When the operation is over you will be called down to recovery to see your child and bring them back to the ward.
During the operation painkillers will be given to make sure that when your child wakes up they are not in any pain. They will be given painkillers afterwards as well, and it is important that if they start to feel any pain
you tell one of the nurses. Your child will be in a plaster cast and will have their leg elevated on pillows. This is to stop any swelling after the operation and make sure your child is comfortable. Your child will be able
to eat and drink when they feel hungry.
Later on, one of the physiotherapists will visit and help your child stand and start walking either with a zimmer frame, or crutches. Your child will have a special plaster shoe to put on their cast. They will be able to put weight through their leg if it feels comfortable but they may not feel like doing this straight away.
When the physiotherapist is happy that your child is safe mobilising oncrutches or with a frame, and they have been to the toilet, had something to eat and drink, and the nurses are happy, you will be able to go home. This will often be the same day, but will depend on the time of the operation. We may want you to stay in hospital overnight. If this is the case then one parent will be able to sleep overnight.
A wheelchair is not provided by the hospital and is not usually needed. If you feel it would make life easier for your family, you should source your own paediatric wheelchair or large pushchair.
Wheelchair advice eg/ Red Cross / Wheel freedom / mobility hire:
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Please avoid getting your child’s plaster cast wet. If it becomes wet ordamaged, please contact the plaster room directly on 020 8909 5467.
Your child will be booked for a plaster clinic appointment 4 to 6 weeksafter surgery. The plaster cast will be removed using a plaster saw. The operation wounds will be checked. Usually a night splint will be
measured at this stage by an Orthotist in the plaster clinic. A plaster cast will be applied to the lower leg and removed straight away to be used as a mould to make an AFO (Ankle Foot Orthosis) for your child. This
is made of plastic with Velcro straps. It is designed for your child to be worn in bed at night and helps to keep the calf muscle stretched and the tendon transfer working properly.
After the orthotist has measured your child for a splint, a new walking cast will be applied for two weeks while the AFO is made.
The final cast is removed 6 weeks after surgery. The cast will be removed using a plaster saw. The activity of the Tibialis Anterior muscle will be checked by the surgical team, and your child will be encouraged to
weight-bear fully on the foot and walk by themselves.
It can take a few days to a couple of weeks to return to normal walking activity. Every child is different and should go at their own pace.
If a night-time AFO has been made, you will now collect this from the orthotics department. Final adjustments may be made to ensure it fits comfortably. It should be worn every night for at least the next 12 months.
Your child will be given an appointment to see the Paediatric Physiotherapyteam at RNOH , 1-2 weeks after the final cast has been removed. The physiotherapist will assess your child and provide advice, exercises and stretches to continue post-operative rehabilitation. Usually 2-3 sessions of physiotherapy intervention are offered.
Exercises may include:
Calf muscle stretch in standing Balance on one leg
Doing these exercises daily will ensure the best result from surgery.
There is an excellent resource for exercises designed for children who have Ponseti treated clubfoot here Strong and Stretchy - Global Clubfoot Initiative.
Your child will be followed up in clinic, 6 weeks after plaster cast removal, with Miss Sally Tennant, Consultant Orthopaedic Surgeon, or one of her team. Your child will be assessed on walking ability, range of movement and active muscle strength.
You may be referred back to the paediatric physiotherapy team if more rehabilitation is required. If all is going well you will be reviewed again in the clinic a few months later.
Research suggests it can take up to 12 months after surgery to see the full benefit of having a Tibialis Anterior Tendon Transfer operation.
At 12 months after the procedure we usually want you to have another gait lab assessment so we can see the effect of the operation.
Will my child be able to walk with plaster casts?
Your child will be able to walk with plasters casts on. For the first 1-2weeks after surgery, usually walking is limited by pain and walking aids may be used if needed.
Will my child be able to attend school while they are in plaster casts?
You will need to discuss school attendance with your child’s school. There are no restrictions advised from the hospital on school attendance. You can request a letter from the clinical team for specific school advice if needed.
Are there any restrictions on my child’s activity after surgery?
Your child will not be able to walk very far and won’t be able to run. They won’t be able to do any activity which might get the cast wet.
When can they return to contact sports?
Once your child is walking and running normally they will be able to return to normal sporting activities. This will often be 6-12 weeks after the cast is removed.
Miss Sally Tennant, Consultant Orthopaedic Surgeon
Secretary to Miss Tennant:
Tel: 020 8909 5758
Ms Christine Douglas, Consultant Paediatric Physiotherapist
Email: christinedouglas1
Ms Cicily James, Specialist Ponseti Practitioner
Email: cicily.
Ponseti clinic
Email: rnoh.
Plaster Room
Tel: 020 8909 5467
Orthotics Department
Email: rnoh.
Tel: 020 8909 5418
Coxen Ward
Tel: 020 8909 5487
Children’s Physiotherapy
Email: rnoh.
Tel: 020 8909 5821
23-49 © RNOH
Date of last review: November 2023
Date of next review: July 2026
Authors: Christine Douglas, Consultant Paediatric Physiotherapist
Sally Tennant, Consultant Orthopaedic Surgeon
Page last updated: 07 July 2026