Lengthening of Achilles Tendon from the Percutaneous Tenotomy Procedure in Ponseti’s Method
Abstract Background Talipes equinovarus is one of the common congenital disease of foot deformity of newborn. Initial treatment is often with the Ponseti method. Studies have demonstrated that radiographic measurements can be made with clubfoot. The purposes of this study were to document the amount of Achilles tendon lengthening obtained from PAT in Ponseti’s method and to analyze the factors that might impact on the amount of equinus correction. Methods This is a retrospective study carried out from 2002 to 2006. Sixteen feet of twelve children that received percutaneous Achilles tendon tenotomy (PAT) for the treatment of congenital clubfoot were included. Assessments before and after treatment were performed using Dimeglio system. The foot length from toe to heel at the time of PAT, the pre- and post-PAT ankle dorsiflexion and post-casting lateral view of foot were obtained. The Pearson correlation coefficient was used to establish relationships between pre-, post-PATT and post-casting Tibio-calcaneal angle (TCA) and Achilles tendon length(ATL).Results The TCA before, after PATT, and after casting were -9.3, 27.4 and 18.4degrees. The ATL before, after PATT, and after casting were 22.7, 31.3, and 28.3mm. The overall lengthening of Achilles tendon was 5.7% of the foot length. The pre-PATT TCA was correlated with post-PATT and post-casting TCA. The pre-PATT ATL was correlated with post-PATT ATL and post-casting ATL.Conclusion Post-PAT correction effect is negatively correlated with the pre-PAT severity of equinus. The comparison between post-PAT and post-casting TCA could be used to check the quality of casting in the Ponseti method.Level of Evidence: level IV