The impact of the early tenotomy of Achilles tendon on the length  and results of congenital clubfoot severe forms treatment

Zoran  Rakonjac

doi:10.2298/VSP170815167R

Zoran Rakonjac University Clinical Center of Banjaluka, Clinic for Children’s Surgery, Banjaluka, Bosnia and Herzegovina

DOI: https://doi.org/10.2298/VSP170815167R

Keywords: foot deformities, congenital abnormalities, orthopedic procedures, achilles tendon, prognosis

Abstract

Abstract

Background/Aim. In this paper we present our modification of the Ponseti method which we have been using for the treatment of severe forms of congenital clubfoot since 2007. The aim of this paper was to determine, on the basis of the analysis of results, the impact of the early tenotomy of the Achilles tendon on the length and results of treatment of severe forms of congenital clubfoot. Methods. The study was prospective and lasted from 2007 to 2016 year. It was implemented in the Clinic for Children's Surgery Banjaluka. The Group 1 consisted of the subjects treated by the modified Ponseti method in the period of 9 years (2007–2016). There were a total of 30 subjects (52 feet). There were 20 (67%) of male and 10 (33%) of female subjects. There were 22 (77%) subjects with bilateral and 8 (27%) with unilateral deformity. The Group 2 consisted of the subjects treated by the classic Ponseti method in the period of 9 years (2007–2016). There were a total of 32 subjects (52 feet). There were 26 (81%) of male and 6 (19%) of female subjects. There were 20 (63%) of subjects with bilateral and 12 (37%) with unilateral deformity. We used the Pirani score for: classification of deformity according to the severity, monitoring of results of the correction, determination of indication for tenotomy of the Achilles tendon and for the analysis of results of the treatment. Results. The total length of treatment in the Group 1 was from 6 to 9 weeks (mean = 6.71 ± 0.871), and in the Group 2 from 9 to 12 weeks (mean = 9.92 ± 0.882) (r = 0.86; p = 0.001). There was no difference in the results of the treatment (χ²= 2.372 df = 2 n = 52 p = 0.936. Conclusion. Applying early tenotomy of Achilles tendon in the treatment of severe forms of congenital club foot significantly shortens the duration of treatment and has no negative impact on the results of treatment.

References

REFERENCES

Dimeglio A, Bensahel H. Classificationof clubfoot. J Pediatr Or¬thop B 1995; 1995; 4(2): 129–36.

Pirani S, Zeznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop 2001; 21(6): 719–26.

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

Carroll NC. Clubfoot in zhe twentieth centry: Where we were and where we may be going in the twenty century. J Pediatr Orthop B 2010; 21(1): 1–6.

Catherine M, Salazar JJ, Lee H. Surgical Versus Ponseti Ap-proach for the Management of CTEV: A Comparative Study Duffy. J Pediatr Orthop 2013; 33(3): 326–32.

Chaweerat R, Kaewpornsawan K, Wongsiridej P, Payakkaraung S, Sin¬noi S,Meesamanpong S. The effectiveness of parent manipula-tion on newborns with postural clubfoot: a randomized con-trolled trial. J Med Assoc Thai 2014; 97Suppl 9: S68–72.

Chen RC, Gordon EJ, Luhmann SJ, Schoenecker PL, Dobbs MB. New Dynamic Foot Abduction Orthosis for Clubfoot Treat-ment. J Pediactr Orthop 2007; 27(5): 522–8.

Chong DY, Finberg NS, Conklin MJ, Doyle JS, Khoury JG, Gilbert SR. Prospective evaluation of the use of Mitchell shoes and dynamic abduction brace for idiopathic clubfeet. J Pediatr Or-thop B 2014; 23(6): 501–4.

Desail S, Aroojis A, Mehta R. Ultrasoud Evaluation of Club-foot Correction During Ponseti Treatment: A Preliminary Re-port. J Pediactr Orthop 2008; 28(1): 53–9.

George HL, Umikrishman PN, Garg NK, Sampath J, Bruce CE. Uni¬lateral foot abduction orthosis is it substitutie for Denis Browne boots following Ponseti technique. J Pediatr Orthop 2011; 22(1): 22–5.

George P, Robin W. Preoperative Equinus Angle and Prognosis in Congenital Talipes Equinovarus: A Preliminary Report Tse-lentakis. J Pediatr Orthop B 2000; 9(3): 201–6.

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

Limpaphayom N, Kerr SJ, Prasongchin P. Idiopathic clubfoot: ten year follow-up after a soft tissue release procedure. Int Orthop 2015; 39(1): 81–6.

Morcuende A, Abbasi D, Dolan L, Ponseti I. Results of an Acceler¬ated Ponseti Protocol for Clubfoot. J Pediatr Orthop 2009; 25(5): 623–6.

Nasr P, Berman L, Rehm A. Ultrasonographic findings after Achilles tenotomy during Ponseti treatment for clubfeet: Is ul-trasound a reliable tool to assess tendon healing? J Child Or-thop 2014; 8(5): 405–11.

Ramírez N, Flynn JM, Fernández S, Seda W, Macchiavelli RE. Ortho¬sis noncompliance after the Ponseti method for the treatment of idiopathic clubfeet: A relevant problem that needs reevaluation. J Pediatr Orthop 2011; 31(6): 710–5.

Stephan C, Herzenberg JE, Araujo FF. Accurate determination of cast weight for neonates with clubfoot. J Pediatr Orthop 2000; 20(2): 230–3.

Thacker MM, Scher DM, Sala DA, van Bosse HJ, Feldman DS, Leh¬man WB. Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop 2005; 25(2): 225–8.

Zionts LE, Dietz FR. Bracing following correction of idio-pathic clubfoot using the Ponseti method. J Am Acad Orthop Surg 2010; 18(8): 486–93.

Ponseti IV, Smoley EN. Congenital Clubfoot: The Results of Treatment. Iowa Orthop J 1984; 4: 24–33.

Abdelgawad AA, Lehman WB, Bosse HJP, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: Minimum 2-year follow-up. J Pediatr Orthop B 2007; 16(2): 98–105.