BACKGROUND: Ponseti serial casting is the most commonly used method in North America to treat children with clubfeet. Despite initial correction, recurrence is common. tibialis anterior tendon transfer (TATT) is commonly used to treat recurrent clubfeet. Recurrence can occur after TATT, and patients at risk of recurrence may benefit from closer monitoring. We studied the rate of second recurrence (recurrence after TATT) and studied the predictive factors for this recurrence.METHODS: Retrospective chart review of patients who have undergone TATT for recurrent clubfeet between 2002 and 2010 at our institution was performed. Recurrence was defined as recurrence of any elements of the clubfoot deformity that requires operative or nonoperative treatment. Effect of age at the time of TATT, initial severity of the deformity, and family history of clubfoot on rate of recurrence was studied.RESULTS: Sixty patients with 85 clubfeet were included in the study. Sixteen feet in 12 patients (20%) developed recurrence after TATT. Eight feet were treated nonoperatively and the rest (8 feet) required surgical procedure. Young age at time of TATT and brace noncompliance significantly increased the rate of second recurrence. Effect of severity of initial deformity and family history did not reach statistical significance.CONCLUSIONS: Second recurrence can happen in around one fifth of patients with clubfeet after TATT. Patients with young age at TATT and patients with brace noncompliance are at an increased risk of recurrence and should be monitored closely.LEVEL OF EVIDENCE: Level II-prognostic.