Predicting The Outcomes Of Achilles Tenotomy For Children Treated With The Ponseti Method For Congenital Talipes Equinovarus

Abstract

Background: One of the most common birth defects is Congenital Talipes Equinovarus (CTEV) which includes the musculoskeletal system. The occurrence of CTEV is about 2/1000 live births. The Ponseti method was founded in 1972 and has now become the gold standard for treating idiopathic clubfoot nowadays. It is a method that consists of weekly manipulation and serial casting. The process of making a small incision in the Achilles tendon is known as percutaneous Achilles tenotomy which is an essential part of the Ponseti method.

Objective: This research aims to study children with congenital talipes equinovarus (CTEV) and determine the outcomes of Achilles tenotomy after curing them with the Ponseti method to

Study design: A cross-sectional study

Place and Duration: This study was conducted at Ghulam Mohammad Mahar Medical College Sukkur from January 2022 to January 2023.

Methodology: All of the participants of this study were children with ages ranging from newborn to 2 years. Pirani scoring was used to measure the severity of the clubfoot. The scores were from 0 to 6 where 6 score determines the severe deformity. The Ponseti serial casting was done every week. At the end of the serial casting, brace treatment without tenotomy was started for those children who do not have residual equinus deformity. Those children who had a Pirani score of 1 or 0.5, and had corrected cavus, and varus along with the head of the talus at the end of casting were given percutaneous Achilles tenotomy under local anesthesia. For these children, the final cast was applied for 2 weeks after the Achilles tenotomy.

Results: Overall, 60 children with CTEV were enrolled in this research. The mean age of the children at the time of Achilles' tenotomy was 10.3 weeks. A total of 76.67% of the children were having unilateral clubfoot deformity and only a small percentage of children had bilateral clubfoot deformity. Overall 66.67% of the children had Achilles tenotomy as equinus deformity should be corrected before the last cast application.

Conclusion: Our research had a very high frequency of Achilles tenotomy after using the Ponseti method because the majority of the participants had persistent equinus deformity