The insertion of the tendon of the tibialis posterior has been dissected in fifty-six feet with recurrent club-foot. This insertion was abnormal in all instances. The tendon was thickened and at the medial malleolus changed into a thick fibrous mass, inserting with extensions to fascia, ligaments, and bones at the medial, dorsal, and plantar aspects of the foot.

As the tibialis posterior is the only muscle able to produce club-foot by its contraction or shortening alone, deformity of this muscle is seen as one of the main reasons for the development of club-foot. Considering this, the tibialis posterior was transferred, after excision of the abnormal insertion, to the anterior plane of the foot and sutured to time third cuneiform. Achilles-tendon lengthening and posterior capsulotomy were performed at the same time to overcome equinus deformity.

Thirteen of the patients were followed for at least four years. Good results were obtained in twelve patients; seven of the results were classified as excellent with full correction of deformity and full function. In five, some minor deformity remained or walking on tip-toe was not possible. Overcorrection resulted in one patient and the result was regarded as unsatisfactory.