Split tibialis anterior tendon transfer (SPLATT) factsheet
Introduction
The tibialis anterior is a tendon on the front of the lower leg, just below the knee.
It extends down towards the ankle and connects to the bones on the inside of the foot near the arch. The tibialis anterior helps move the foot and ankle:
- upwards, towards the shin bone
- inwards, towards the other foot.
When the tibialis anterior muscle is overactive or tight, it can pull the foot inward. This can cause your child to put more of their weight on the outside edge of the foot when walking, which can lead to:
- pain
- issues with the skin
- rolling of the ankle.
The Split Tibialis Anterior Tendon Transfer (SPLATT) is used to correct this condition. The procedure aims to:
- rebalance the pull of the tibialis anterior
- make sure the foot is held in a straight position, not pulled inwards.
This procedure can be done alongside other bone and muscle surgeries.
Before the procedure
Your child’s treatment team will let you know if any tests or scans need to be done and whether they need to see a physiotherapist or occupational therapist before the procedure
The hospital will call you before your child’s procedure to let you know:
- what time you need to arrive
- when your child needs to stop eating and drinking
- how long your child may need to stay in the hospital.
You may also want to tell:
- your child’s school of their surgery
- your workplace that you may need time off around the surgery
- friends and family who may be able to help out while your child is recovering.
During the procedure
Your child will be under a general anaesthetic for the procedure. This means they will be asleep and will not feel any pain.
In the SPLATT procedure:
- the tendon is cut in half
- one half is moved to the outside of the foot and is secured to the bone
- the other half stays attached to the bone on the foot's inner side.
After the procedure
After the procedure, your child will be given pain medicine. In hospital, pain management is provided through either:
- a nerve block
- a drip
- oral medicine.
While resting, your child’s leg will be elevated or raised for the first few days.
The foot will be held in place with a below-knee plaster, which will stay on for around six weeks.
Your child’s doctor will let you know when they can go home from hospital. This will depend on:
- their recovery
- whether any other procedures were done at the same time.
Your child’s doctor will let you know when they can put weight on their leg after surgery. This could be between 6-8 weeks while the bone heals.
Your child may need to use some aids before this to help them get around, such as:
- crutches
- walking frame
- wheelchair.
Management
Caring for your child at home
The hospital will make sure you have pain medicine and instructions for your child when you take them home from the hospital. It is important to follow the pain medication instructions carefully, giving them before:
- moving from one position to another
- showering
- toileting.
Your child might need equipment to help with movement and everyday activities while recovering. Equipment can include:
- a wheelchair
- a commode - a special chair that makes toileting and showering easier.
Your child will see an occupational therapist (OT) who will help you organise equipment. An OT or physiotherapist can also help your child with:
- using equipment
- moving around
- strength exercises.
Showering and bathing
The leg plaster cannot get wet.
Before bathing or showering, you must cover your child’s plaster with a large plastic bag taped in place. This is to make sure it stays dry.
Speak to your child’s doctor if the cast gets wet, as this can cause skin irritation and infection.
Pressure injuries
To prevent blisters or pressure injuries, it's important to ensure that your child changes position regularly. Avoid having the heel of the cast rest on any surface; instead, prop up the leg with cushions.
Ankle Foot Orthosis
Your child must wear an ankle foot orthosis (AFO) after surgery for at least three months after the procedure.
An AFO is a brace worn around the ankle and foot. It helps:
- to provide support to the area
- the tendons continue to heal properly
- make sure the corrected foot position is maintained.
Not wearing the AFO can cause the foot to return to its original shape.
Your child’s treatment team will give you information about the AFO and sizing.
