DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20173941

Functional outcome of tendoachilles following Ponseti’s tenotomy for treatment of congenital talipes equino varus in children older than two years

Sunny Agarwal, Suresh B., Mathew Varghese, Vishesh Khanna, Mandeep Singh Bajaj

Abstract


Background: Long term results of tenotomy and Ponseti technique are established worldwide. However, functions of Tendoachilles following Ponseti’s tenotomy in these cases i.e. idiopathic/neglected/operated/relapsed clubfeet (after casting or surgical correction) are not established. Tendoachilles regeneration after tenotomy has been confirmed on USG and MRI but only a few studies have done functional evaluation of tendoachilles. This study was done to evaluate the functional outcome of tendoachilles after tenotomy in patients older than two years presenting with CTEV. This study also assessed the influence of age and any previous treatment on tenotomy.

Methods: In this study, 42 children (68 clubfeet) were seen in the two year study period. Children between 2-13 years coming to the outpatient department for treatment using the Ponseti’s method were followed during and after completion of treatment for 2 years. Patients were divided into two groups-first according to age and second according to previous treatment. Clinical evaluation of tendoachilles regeneration was done by evaluating the child’s ability to stand on tip of toes on single leg and walking ability.

Results: The ability to stand on tip of toes after removal of the final cast was delayed maximum in the previously operated patients (9.5 weeks), lesser in patients who were previously treated by casting (7.3 weeks) and least in neglected patients (7 weeks). It also increased as the age increased (2-5 years age group required 7.4 weeks whereas 11-13 years age group required 16 weeks). Neglected patients started walking earlier (4.6 weeks) as compared to patients treated conservatively (4.8 weeks) or operatively (7.2 weeks). Younger children started walking earlier (age 2-5 years required 4.7 weeks whereas 11-13 years age group required 12 weeks).

Conclusions: Functional evaluation of tendoachilles showed that all children who had tenotomy could walk and stand on tip of toes irrespective of age and previous treatment. However, older child and children having history of previous treatment, required longer time for recovery.


Keywords


CTEV, Ponseti techniques, Tendoachilles tenotomy, Tendoachilles function

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References


Ponseti IV. Clubfoot: Ponseti Management: Global Help Publications; 2003.

Herring JA. Tachdjians Pediatric Orthopaedics: Congenital Talipes Equinovarus. WB Saunders Co; 2002.

Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop. 1990;10(1):109–19.

Ponseti IV. Treatment of Congenital Clubfoot. J. Bone & Joint Surg Am. 1992;74:448-54.

Ponseti IV. Congenital Clubfoot: Fundamentals of Treatment. Oxford University Press; 1996.

Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2003;42(5):259–67.

Scher DM, Feldman DS, van Bosse HJP, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004;24(4):349–52.

Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004;113(2):376–80.

Saini R, Dhillon MS, Tripathy SK, Goyal T, Sudesh P, Gill SS, et al. Regeneration of the Achilles tendon after percutaneous tenotomy in infants: a clinical and MRI study. J Pediatr Orthop B. 2010;19(4):344–7.

Maranho DAC, Nogueira-Barbosa MH, Simão MN, Volpon JB.Ultrasonographic evaluation of Achilles tendon repair after percutaneous sectioning for the correction of congenital clubfoot residual equinus. J Pediatr Orthop. 2009;29(7):804–10.

Agarwal A, Qureshi NA, Kumar P, Garg A, Gupta N. Ultrasonographic evaluation of Achilles tendons in clubfeet before and after percutaneous tenotomy. J Orthop Surg Hong Kong. 2012;20(1):71–4.

Mangat KS, Kanwar R, Johnson K, Korah G, Prem H. Ultrasonographic phases in gap healing following Ponseti-type Achilles tenotomy. J Bone Joint Surg Am. 2010;92(6):1462–7.

Ferreira RC, Costo MT, Frizzo GG, da Fonseca Filho FF. Correction of Neglected Clubfoot Using the Ilizarov External Fixator. Foot Ankle Int. 2006;27(4):266–73.

El-Mowafi H. Assessment of percutaneous V osteotomy of the calcaneus with Ilizarov application for correction of complex foot deformities. Acta Orthop Belg. 2004;70(6):586–90.

Dobbs MB, Nunley R, Schoenecker PL. Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am. 2006;88(5):986–96.

Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62(1):23–31.

Spiegel DA, Shrestha OP, Sitoula P, Rajbhandary T, Bijukachhe B, Banskota AK. Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age. Clin Orthop. 2009;467(5):1164–70.

Lourenço AF, Morcuende JA. Correction of neglected idiopathic club foot by the Ponseti method. J Bone Joint Surg Br. 2007;89(3):378–81.