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Frequency of Achilles Tenotomy in Patients with Congenital Talipes Equinovarus (CTEV) Treated with Ponseti Technique.
Keywords:
Achilles, Club foot, Pirani, Ponesti, Tenotomy.Abstract
Objective: To determine the frequency of Achilles tenotomy in patients with Congenital Talipes Equinovarus (CTEV) treated with Ponseti serial castings.
Methods: This descriptive study was conducted in department of Orthopedic Surgery Khyber Teaching Hospital Peshawar from 12th September 2019 to 12th December 2020. All children of CTEV who were treated with Ponseti serial castings and fulfilled our inclusion criteria were enrolled in this study. Achilles tenotomy was performed at the end of casting in those children who had corrected cavus, varus with head of talus covered and with Pirani Equinus score of 1 or 0.5. The frequency of tenotomy was noted. Important variables of children with tenotomy were stratified and post stratification Chi-square test was applied to calculate P value. P value< 0.05 was considered significant.
Results: We treated 86 feet in 69 children with Ponsti serial castings. Majority (75.36%,n=52) of children had unilateral club foot deformity while 17(24.63%) had bilateral deformity. Male children were 41(59.42%) while 28(40.57%). The mean age at the time of Achilles tenotomy was 10.3+0.28 weeks. The initial Pirani score was 3+0.74 and final Pirani score was 1+0.74. Correction was achieved in 5+0.84 castings. Achilles tenotomy was done in 57 (66.27%) feet to correct the equinus deformity before application of final cast.
Conclusion: The frequency of Achilles tenotomy after Ponesti serial casting was high as more than half our children had persistent equinus deformity.
References
Asuquo JE, Abang IE, Anisi C, Urom S, Agweye P, Ngim NE, et al. Descriptive epidemiology and predisposing factors to idiopathic talipes equino varus in South South Nigeria. J Public Health Epidemiol 2016;8:147-150.
Khan S, Khanzada S. Ponseti treatment for idiopathic clubfoot deformity, Role of secondary care Hospitals. J Pak Med Assoc 2016;66(1):111-114.
Jaqueto PA, Martins GS, Mennucci FS, Bittar CK, Zabeu JL. Functional and clinical results achieved in congenital clubfoot patients treated by Ponseti's technique. Rev Bras Ortop 2016;51(6):657-659.
Ponseti IV, Smoley EN. Congenital club foot: the results of treatment. J Bone Joint Surg Am 1963;45(2):261-264.
Sinha A, Mehtani A, Sud A, Vijay V, Kumar N, Prakash J. Evaluation of ponseti method in neglected clubfoot. Indian J Orthop 2016;50(5):529-535.
Hernigou P, Gravina N, Potage D, Dubory A. History of club-foot treatment; part II: tenotomy in the nineteenth century. Int Orthop 2017;41(10):2205-2209.
MacNeille R, Hennrikus W, Stapinski B, Leonard G. A mini-open technique for Achilles tenotomy in infants. J Child Orthop 2016;10(1):19-23.
Anisi CO, Asuquo JE, Abang IE, Eyong ME, Osakwe OG, Ngim NE. The role of Pirani scoring in predicting the frequency of casting and the need for percutaneous Achilles tenotomy in the treatment of idiopathic clubfoot using the ponseti method. Paediatr Orthop Relat Sci 2017;3:55-40.
Anisi C, Asuquo JE, Abang I, Agweye P. Frequency of percutaneous Achilles tenotomy in the treatment of idiopathic clubfoot using the ponseti method.. Niger J Med 2018;27:163-167.
Parikh K, Moradiya NP. Outcomes of congenital talipes equino varus treated with ponseti method.Int J Con Med Res 2019;6(1):27-30.
Dobbs MB, Morcuende JA, Gurnett CA, Ponseti IV. Treatment of idiopathic clubfoot: an historical review. Iowa Orthop J 2000;20:59-64.
Lebel E, Karasik M, Bernstein-Weyel M, Mishukov Y, Peyser A. Achilles tenotomy as an office procedure: safety and efficacy as part of the Ponseti serial casting protocol for clubfoot.J Pediatr Orthop 2012; 32(4):412-415.
Pirani S, Outerbridge H, Moran M, Sawatsky B. A Method of Evaluating the Virgin Clubfoot with Substantial Inter-observer Reliability. Read at the POSNA Annual Meeting; 1995.
Ponseti IV. Common errors in the treatment of congenital clubfoot. Int Orthop 1997;21:137-41.
Khan AM, Anwar SF, Saif AB, Awan SA. Effectiveness of Pirani Score in predicating selection of Achilles tenotomy in idiopathic club foot: A case control study. Pak Armed Forces Med J 2020; 70 (5): 1376-80
Islam MS, Masood QM, Bashir A, Shah FY, Halwai MA. Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study.Clin Orthop Surg 2020;12(1):100-106.
Ayehualem S, Asmare Y, Abrha M, Muche A.Prediction of Number of Casts and Need of Tenotomy Using Pirani Score in the Management of Clubfoot. Journal of Craniofacial Surgery 2019; 30(5):477-481.
David BH, Olayinka A, Oluwadare E, Ayodele OE, Joseph M, Olujide A. Predictive value of Pirani scoring system for tenotomy in the management of idiopathic clubfoot. J Orthop Surg (Hong Kong) 2017;25(2):145-151.
Kulambi V, Gaurav M, Naveen D S. Study of factors predicting the need for tenotomy in correction of clubfeet by ponseti method. J Orthop Traumatol Rehabil 2017;9:38-40
Shah MQ, Khan A, Zardad MS, Iqbal R, Ahmed S. Ponseti Technique For Management Of Congenital Idiopathic Club Foot.J Ayub Med Coll Abottabad 2017;29(2):246-249.
Smythe T, Chandramohan D, Bruce J, Kuper H, Lavy C, Foster A. Results of clubfoot treatment after manipulation and casting using the Ponseti method: experience in Harare, Zimbabwe. Trop Med Int Health 2016;1:1311–1318.
Aydin BK, Senaran H, Yilmaz G, Acar MA, Kirac Y. The need for Achilles tenotomy in the Ponseti method. Journal of Pediatric Orthopaedics B 2015; 24(4):341–344.
Adewole OA, Williams OM, Kayode MO, Shoga MO, Giwa SO. Early Experience with Ponseti Club Foot Management in Lagos, Nigeria. East and Central African Journal of Surgery. 2014;19(2):72–77.
Khan MK, Kabir SK, Iqbal J, Durrani Z.Frequency of Achilles? Tenotomy in Club Foot treated by Ponseti Method. Ophthalmol Update 2014;12(1):72-74.
Khan MK, Kabir SK, Khan MS, Iqbal J. Outcome of ponseti technique for idiopathic clubfoot using pirani scoring system. J Med Sci 2013; 21(4): 190-93.
Scher DM, Feldman DS, van Bosse HJ, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop 2004: 24: 349-352.
Jain G, Lenka S, Chandra M, Mohanty T. Higher Rates of Achilles Tenotomy after a Didactic Session on Ponseti Method Arch Bone Jt Surg 2020;8(4):549-551.
Sharma A, Shukla S,B Kiran B, Michail S, Agashe M. Can the Pirani Score Predict the Number of Casts and the Need for Tenotomy in the Management of Clubfoot by the Ponseti Method? Malays Orthop J 2018;12(1):26-30.
MacNeille R, Hennrikus W, Stapinski B, Leonard G. A mini-open technique for Achilles tenotomy in infants with clubfoot. J Child Orthop 2016;10(1):19-23.
Sharma S, Butt MF, Singh M, Sharma S. The posterior to anterior controlled technique of percutaneous Achilles tenotomy in the correction of idiopathic clubfoot: a technical report. J Pediatr Orthop B 2013;22(3):249-251.
Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. Journal of Pediatric Orthopaedic. 2004 ;24(4):353–357.
Burghardt RD, Herzenberg JE, Ranade A. Pseudoaneurysm after Ponseti percutaneous Achilles tenotomy: a case report. Journal of Pediatric Orthopaedics 2008 ;28(3):366–369.
