Tendon transfer in foot deformity

partial tendon transfer of tibialis anterior

Common causes of foot deformity are polio, cerebral palsy, meningo-myelocoel, CTEV, nerve injury. If this deformity is because of muscle imbalance then it will need tendon transfer along with correction of deformity. Chance of recurrence of deformity became lesser by the use of tendon transfer. We utilize the tendon from remaining muscle in extremity that after transfer do not interfere much in important function of limbs. Selection of tendon is very important during surgery. Power of transferred tendon should be Grade 5 but never less than 4 because after transfer power may decrease upto 1 grade and it should in same direction of pull of weak muscles. 

you tube link to few cases with tendon transfer 

We can utilize complete or half of tendon in transfer. Half tendon transfer are being utilized commonly in cerebral palsy & ctev affected foot. In ctev & cerebral palsy we utilized half tendon of tibialis Anterior to lateral side of foot to balance over action of forefoot inversion and half tendon of tibialis posterior in hind foot inversion of cerebral palsy foot . In foot drop, we transferred tibialis anterior to mid portion of foot and in calcaneous foot we transfer peronie & inverter muscle posterior toward insertion of tendoachilis. After tendon transfer, foot will be protected with plaster for 1 month and then with brace. Vigorous therapy can be started after 6 week and child will to walk after 2 month with brace. Person has to wear brace minimum 3-4 months.


for more information contact

Dr Jitendra kumar Jain

pediatric orthopedic surgeon cum foot surgeon

www.trishlaortho.com & www.trishlafoundation.com

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Management of hand problem in cerebral palsy by tendon transfer and SEMLOSSS

IMG_1358   IMG_2314

Upper extremity involvement in cerebral palsy interferes with proper use of hand and it is most challenging for therapist and surgeon to deal with it. In upper extremity they can have problem in shoulder, Elbow, wrist, and fingers. Problem can be of combination of lifting of upper limb above the shoulder, reaching out to object or not able to perform fine activity by hand.  It is also very important that preference of hand became fixed at the age of two year so it became imperative to start therapy at earliest to get maximum outcome before the age of 2-3 year age.  We have many ways of therapy for hand like Bimanual, CIMT, sensory integration & proper occupational therapy. Affected hands in cerebral palsy have manifold problem like weakness, spasticity, contracture & sensory problem.  Most difficult to treat problem in upper limb is non recognition of fine motor activity by cortical center in brain so that they are not able perform activity at their own in coordinated manner. Most important problem that interferes in therapy is contracture and spasticity in extremity that is too being managed at early. In early age (2-5 year), it can be managed by botulinum toxin but child develop fixed contracture then they require surgical intervention. earlier we use to do tendon lengthening of all affected tendon require long rest of hands and rehab can be started after months and recovery was not so good every time. But with the new concept of OSSCS & SEMLOSSS we use to relieve spasticity & contracture by aponurotic (facial coverage at musculo-tendinous junction) release by this technique we can start therapy early and child regain function in very short time. Some time these children also have weakness in few group of muscle so we also utilized the concept of tendon transfer. This tendon transfer help in regaining muscle power and good functional recovery.

Video of outcome of tendon transfer in cerebral palsy affected hand of few children & adolescent

few children It is very important to continue therapy for log duration till complete recovery. Child should wear brace as advised their operating surgeon and therapist concerned. By use of all this modality we can give good functional recovery to child.

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Early surgical intervention in Spastic Cerebral Palsy

MVI_2387 2


Role of surgical intervention in children with cerebral palsy arise when we think that child is not improving with therapy any more & he resist to go for therapy at all. If none responding to therapy is because of development of fix deformity, weakness in some group of muscle, contracture of muscle & tendon along with torsional deformity of bone then child really need some intervention to tackle this entire problem. In early age it can be managed by therapy & braces and some time botulinum toxin.

Most of the time, gait is matured between the age of 5-6 year age. After maturity of gait all these measure fail to give any benefit to these children then we really need some surgical intervention to prevent development of permanent deformity that can interfere in further functional improvement. Ideal age of surgical intervention is about 6-9 year age.  


Latest advancement in management in cerebral palsy

Every parents of children with any kind of physical disability specially cerebral palsy will have a desire of nearly normal looking his own child  as much as possible & he/she will try their best to get this outcome. In search of best outcome, they will always wondering from one place to other. When their child has minor disability then they will always looking for the measure that can manage their complete problem so that their child can play around like other children and their child can mix up with their peer group so that their child never feel ashamed of disability. Now early surgical intervention by the concept of SEMLOSSS can give rise to excellent recovery in the children with cerebral palsy & mild to moderate disability. Link to this you tube video to have real story in these children  — http://youtu.be/7HieYTYEknc

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Dr J K Jain

Cerebral Palsy affected Adult with sever physical disability can also have good quality of life

It is easier to manage children with cerebral palsy even in children with sever deformity(https://www.youtube.com/watch?v=waEsYsoakcc) but as their age increases their problem is proportionately increase and it became very trouble some to manage them. it is not the only that adult is affected but whole family is affected with this problem and with passage of time as their problem increase because of many factor like osteomalacia, obesity, increasing spasticity, deformity and psychological issue , it became very difficult to manage them even for their daily routine activity like transfer, toilet, bathing and feeding. so it became very important to mange all their deformity and spasticity along with other associated medical problem so their routine requirement can be managed in much easier way. now with advancement in medical science most of the medical problem can be managed much easier way. most of the adult are confined to indoor so that most of time they will have osteomalacia & osteoporosis so they should be supplemented with Vit D and calcium. some of them will have obesity and others can have malnutrition so proper nutrition should be taken care at least proper weight and heath should be maintained . overweight always their physical activity and after certain weight they can became bedridden.  proper architectural design should be taken care for barrier free environment at home and at business center so that their movement should not be hampered. if any one of them have deformity of joint and extremity along with unbalanced body then they should be managed by therapeutic & surgical modality (https://www.youtube.com/watch?v=3tf_Khcc4f8) . all the persisting physical & orthopedic problem should be managed by single event multi level surgery and it can be better managed by SEMLOSSS (http://www.samvednatrust.com/cerebral-palsy/recent-advancements/).

link to www.trishlafoundation.comhttp://trishlaortho.com/  & https://www.youtube.com/user/jjain999 for more information new update on cerebral palsy

Benefit of early intervention in children with cerebral palsy


Most of the time it has been said that child with cerebral palsy will improve on his natural progress and there is no need of any intervention but it is not true as a whole . truth is that if you are not giving proper therapy to child , child is not going to have good quality of progress. By the use of good quality of therapy, different intervention modality and judicious use of bracing can help the child with cerebral palsy in getting good functional improvement and they can change the natural progress of the child .

on of the parents rightly written on his testimonial as ——–

My son  Shivansh Pandey (31/2 years) was a premature baby who could not sit, stand and walk till 21/2 yrs.  Consultants in Faizabad referred him to Dr. J.K. Jain.  On his advise we stayed in Allahabad for 3 months during which Shivansh was treated at Samvedna Trust.  In these 3 months he has improved drastically and started sitting and crawling independently.  He was further injected Botulinum Toxin followed by vigorous physiotherapy.  Today Shivansh can walk 20 – 25 steps independently.  Thanking Samvedna for such unbelievable results. link to you tube video of this child

Vipin Pandey – Faizabad (U.P.)

you can get more information on www.trishlafoundation.com & http://www.trishlaortho.com



A multidisciplinary team including an orthotist, physical therapist and an orthopedist can advance a child with cerebral palsy along the continuum of care throughout his development. This team, coordinating with a family-centered approach to care, should encourage optimal use of an orthosis within the prescribed treatment plan.


If you encounter a pediatric patient with cerebral palsy chances you may find the solution to orthotics treatment with some customized adjustment. To make a truly useful orthosis for a child with cerebral palsy you may also need to know body mechanics and kinematics.

Spastic cerebral palsy is the common type cerebral palsy, found approximately in 80% of children with the disability. Although orthotics intervention has adjusted in small ways to accommodate new research in the body mechanics and gait, the overall goals are the same. The goal of lower limb orthotic management of cerebral palsy is to correct and/or prevent deformity; to provide a base of support to facilitate training in skills and to improve the efficiency of gait. Other goals include increasing range of motion, maintaining or improving levels of function and stability, maintaining length as the bone grow, and preventing and overcoming some the secondary effects of the disability leading into adulthood, no single treatment is appropriate for every child, but it is generally agreed that sooner the intervention is started the better the outcome. Orthoses prescribed to prevent or correct the deformities can pose addition activity limitation by restricting movement . normal functional development can be impeded by impairment of coordination and movement. Orthoses can maintain optimum biomechanical aligment of body segments enable children to overcome activity limitations by focusing training on unrestricted parts for their bodies over which they have better control.

Treatment surgery center children symptom Mobility Exercises in Cerebral Palsy children Treatment surgery center children symptom India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka Afghanistan Bhutan Russia Canada United States PR China Brazil Australia Argentina Kazakhstan Sudan Algeria Greenland Saudi Arabia Indonesia Mongolia Peru Niger South Africa Colombia Egypt Nigeria Venezuela Turkey Chile Zambia Ukraine Kenya France Thailand Spain Sweden Uzbekistan Morocco Iraq Japan Zimbabwe Germany Finland Malaysia Philippines Ecuador New Zealand Netherlands Switzerland Denmark Qatar
Need more information on how to organize your efforts to manage your child’s care?
Call 945-303-9213.
Dr. Jitendra Kumar Jain

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Botox in cerebral palsy

Clinical use of botulinum was recognized by Bergen et al. in 1949 by identifying the effect of botulinum toxin on neuromuscular transmission. Once it was thought to be potent biological toxin to human body, now its potential is being utilized as therapeutic agent for different clinical problems specially spasticity & cosmetic purpose. In all variety of botulinum toxin, type A is used for the clinical application. This is being utilized in Mx of cerebral palsy since 20 years .This toxin is used as intramuscular injection at most condensed site of neuromuscular junction of affected muscle. This toxin block acetylcholine release from neuromuscular junction & causes local temporary chemo- denervation and effect last for 4-6 month .Even after disappearance of drugs, some modulation of nerve transmission has been seen, so effect persist beyond the time limit and dystonic posture also get corrected due to slight diffusion of drugs in systemic manner. It is being commonly used for spastic & dystonic cerebral palsy.


Usually botulinum toxin injection are used in all affected muscle in a single setting and it is better to give it under anesthesia, because it require multiple injection puncture and is painful and it also save the toxin from wastage. Most commonly botulinum toxin is used in Gastrocnemius, Hamstring, Rectus Femoris, Adductor, Pronator Teres, and Flexor Digitorum. Injection can be repeated every three monthly but if proper postoperative therapeutic protocol has been taken into consideration it may not be so frequent. At Samvedna, we rarely require repetition of toxin due to good therapeutic protocol and use of braces. It reduces pain; facilitate therapy, better cooperation of child, better functional and motor gain .By the use of toxin, surgery also can be delayed till the maturity of gait. Antibodies to toxin have been one of the possible problems with repeated injection that can interfere in next injection of toxin. Otherwise it is well tolerated. Side effects are very -2 rare.

Botulinum toxin in cerebral palsy

Treatment surgery center children symptom Mobility Exercises in Cerebral Palsy children Treatment surgery center children symptom India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka Afghanistan Bhutan Russia Canada United States PR China Brazil Australia Argentina Kazakhstan Sudan Algeria Greenland Saudi Arabia Indonesia Mongolia Peru Niger South Africa Colombia Egypt Nigeria Venezuela Turkey Chile Zambia Ukraine Kenya France Thailand Spain Sweden Uzbekistan Morocco Iraq Japan Zimbabwe Germany Finland Malaysia Philippines Ecuador New Zealand Netherlands Switzerland Denmark Qatar
Need more information on how to organize your efforts to manage your child’s care?
Call 945-303-9213.
Dr. Jitendra Kumar Jain

Like us on facebook :  https://www.facebook.com/samvednatrustallahabad

follow us on Twitter :  https://twitter.com/TrishlaOrthoped