Percutaneous Tendo Achilles Tenotomy in the management of Equinus Deformity in conservatively treated CTEV

Abstract

Introduction: Idiopathic clubfoot is the most common musculoskeletal birth defect affecting 1 per 1000 live births. The component deformities of clubfoot include equinus, cavus, heel varus and forefoot adductus. Ponseti method has become the popular method for the non-operative treatment of clubfoot all over the world, and percutaneous tendo Achilles tenotomy is a part of this method which is used to expedite the correction of equinus deformity. Objectives: The purpose of this study was to assess the merits of doing percutaneous tendo Achilles tenotomy by comparing tenotomy group with non tenotomy group. Materials and Method: Seventy-nine consecutive patients with 123 idiopathic clubfeet were treated at Hospital for Bone and Joint Surgery Srinagar. The patients were followed prospectively for 2 years and assessed for the results. All feet were initially graded for the severity of deformity by Dimeglio classification , and treated according to the Ponseti method. At the end of the treatment and during post treatment bracing, the tenotomy group was compared with non tenotomy group. Results: Fifty five (70%) children in the study were males and twenty four (30% ) were females. Forty four patients (55.7%) had bilateral involvement. Sixty four patients (81%) were classified as moderate and severe and 15 feet (19%) as very severe as per Dimeglio classification. Tenotomy of tendo Achilles was done in 84.5 % ( 67patients with104 feet) of the feet.Tenotomy group required an average number of 5.7 casts compared to the non-tenotomy group which required average number of 6.73 casts. Conclusion: In conclusion percutaneous tendo Achilles tenotomy is safe and inexpensive procedure with a very low complication rate.