Mini-Open Technique for the Achilles Tenotomy in Correction of Idiopathic Clubfoot

2008 ◽  
Vol 98 (5) ◽  
pp. 414-417 ◽  
Author(s):  
Ali Dogan ◽  
Ali Murat Kalender ◽  
Ebubekir Seramet ◽  
Mustafa Uslu ◽  
Ahmet Sebik
Keyword(s):  
Present Article ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Open Technique ◽  
Achilles Tenotomy ◽  
Neurovascular Injury ◽  
Equinus Deformity ◽  
Mini Open

Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 feet) during a 3-year period in our clinic on patients whose equinus deformities could not have been corrected by manipulations. Clear improvement (mean angle, 30°) was observed in equinus in our patients, and we have not seen any complication in this method. We conclude that direct visualizing of the tendon with mini-open incision may reduce the risk of neurovascular injury, especially for surgeons who are not experienced. (J Am Podiatr Med Assoc 98(5): 414–417, 2008)

Frequency of percutaneous achilles tenotomy in the treatment of idiopathic clubfoot using the ponseti method

2018 ◽  
Vol 27 (2) ◽  
pp. 163
Author(s):  
ChukwuemekaOkechukwu Anisi ◽  
JosephEffiong Asuquo ◽  
InnocentEgbeji Abang
Keyword(s):  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Achilles Tenotomy

scholarly journals Effectiveness of achillotomy in children with arthrogryposis

2019 ◽  
Vol 7 (2) ◽  
pp. 51-60
Author(s):  
Svetlana I. Trofimova ◽  
Denis V. Derevianko ◽  
Evgeniia A. Kochenova ◽  
Ekaterina V. Petrova
Keyword(s):  
Open Surgery ◽  
Ponseti Method ◽  
Lateral View ◽  
Neutral Position ◽  
X Ray ◽  
Achilles Tenotomy ◽  
Serial Casting ◽  
Equinus Contracture ◽  
The Mean ◽  
Equinus Deformity

Introduction. Ponseti method is a widespread treatment for clubfoot in children with arthrogryposis. Closed subcutaneous achillotomy in these patients could not completely rectify the equinus deformity due to tissue rigidity which often leads to reconsideration of the tenotomy principles. Aim. This study aimed to formulate the anticipating criteria to assess the effectiveness of achillotomy in order to develop a different achillotomy approach for children with arthrogryposis. Materials and methods. This study retrospectively analyzed closed subcutaneous achillotomy in 28 patients (56 feet) with arthrogryposis. The mean age of the patients was 5.4 months (range 2–8 months). The children were subdivided into two groups according to the residual equinus deformity after the completion of Ponseti serial casting. All patients were physically and radiographically examined. Results and discussion. The first group included 12 patients (24 feet), which achieved foot neutral position or dorsiflexion ≥5° after achillotomy. The second group consisted of 16 patients (32 feet) with residual equinus after achillotomy who required surgery. X-ray images showed that the patients in the second group had significantly wider tibiocalcaneal angle and smaller talocalcaneal angle in lateral view (р < 0.01). The correction values of the equinus deformity after achillotomy in the children with arthrogryposis were greatly limited: 27° (20°–30°) and 19° (10°–30°) in the first and second groups, respectively. Conclusion. Closed subcutaneous achillotomy for effective equinus elimination during clubfoot treatment by Ponseti method should be performed only after complete correction at the level of tarsal joints. X-ray examination of the feet is recommended for the children with arthrogryposis in order to evaluate the talocalcaneal divergence and heel position more comprehensively. Furthermore, the values of tibiocalcaneal and talocalcaneal angles in lateral view prior to achillotomy are essential prognostic factors of its effectiveness. Moreover, the severity of equinus contracture should be considered prior to achillotomy. Achilles tenotomy is inappropriate if equinus deformity exceeds 30°. In such cases, open surgery should be considered.

scholarly journals A mini-open technique for Achilles tenotomy in infants with clubfoot

2016 ◽  
Vol 10 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Rhett MacNeille ◽  
William Hennrikus ◽  
Brian Stapinski ◽  
Garrett Leonard
Keyword(s):  
Open Technique ◽  
Achilles Tenotomy ◽  
Mini Open

scholarly journals Achilles tenotomy performed percutaneously under local anesthesia in operation theater room in clubfoot.

2019 ◽  
Vol 26 (09) ◽  
pp. 1477-1481
Author(s):  
Abdul Latif Shahid ◽  
Abdul Latif Sami ◽  
Farhad Alam
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Posterior Tibial Artery ◽  
Ponseti Method ◽  
Peroneal Artery ◽  
Congenital Talipes Equinovarus ◽  
Achilles Tenotomy ◽  
Talipes Equinovarus ◽  
Pediatric Orthopedic ◽  
Mini Open

Objectives: Achilles tenotomy is required in 80 % of cases after the Ponseti method in clubfoot. There are many complications reported if it is perfomed percutaneously under local anesthesia in the clinic. Complications are bleeding from either posterior tibial artery or peroneal artery and sometimes from small saphenous vein. Nerve injuries like tibial nerve and sural nerve are also documented. Incomplete Achilles tenotomy is another complication responsible for recurrence of deformity and redo tenotomy. On the other hand, mini-open Achilles tenotomies performed under general anesthesia in Operation Theater have no such complications as mentioned above. The rationale of this present study is to document the safety and any complications when Achilles tenotomy is performed percutaneously under local anesthesia instead of mini-open technique under general anesthesia in the operation theater room. Study Design: Retrospective review study. Setting: Pediatric Orthopedic Department of the Children Hospital and the Institute of Child Health, Lahore.  Period: 2014 to 2018. Material and Methods: In infants with congenital talipes equinovarus who underwent percutaneous Achilles tenotomy in operation theater room under local anesthesia. Results: Fifty patients with seventy five feet included in this retrospective study who underwent Achilles tenotomy percutaneously under local anesthesia in operation theater room. Before starting Ponseti casts, average Pirani score was 5.6.Before Achilles tenotomy, the average number of casts applied was 4.9.11.9 weeks was the average age at the time of Achilles tenotomy. No vascular, neural and tendon related complications occured in any infants and they discharged from hospital on same day. Conclusions: Achilles tenotomy performed percutaneously under local anesthesia in the operation theater room is more safe and comfortable for both family and pediatric orthopedic surgeon in clubfoot. No vascular, neural and tendon related complications occurred. Operation theater environment and local anesthesia are very beneficial for eliminating any chance of vascular, neural and tendon related complications.

scholarly journals Clubfoot treatment with Ponseti method – Parental distress during plaster casting

2020 ◽  
Author(s):  
Christian Walter ◽  
Saskia Sachsenmaier ◽  
Markus Wünschel ◽  
Martin Teufel ◽  
Marco Götze
Keyword(s):  
Ponseti Method ◽  
Long Term Results ◽  
Congenital Defects ◽  
Idiopathic Clubfoot ◽  
Parental Distress ◽  
Achilles Tenotomy ◽  
Pirani Score ◽  
Plaster Casting ◽  
Initial Hypothesis ◽  
Mental Resilience

Abstract Background: Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot.Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani-Score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani-Score). Therefore, we wanted to investigate weather the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter.Methods: To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting.Results: High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63) and mental resilience (M = 2.25) and. During treatment, mental resilience improved (p = 0.015) significantly. The Spearmann correlation coefficient between Pirani-Score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected. Conclusion: The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.

scholarly journals Clubfoot treatment with Ponseti method – Parental distress during plaster casting

2020 ◽  
Author(s):  
Christian Walter ◽  
Saskia Sachsenmaier ◽  
Markus Wünschel ◽  
Martin Teufel ◽  
Marco Götze
Keyword(s):  
Ponseti Method ◽  
Long Term Results ◽  
Congenital Defects ◽  
Idiopathic Clubfoot ◽  
Parental Distress ◽  
Achilles Tenotomy ◽  
Pirani Score ◽  
Plaster Casting ◽  
Initial Hypothesis ◽  
Mental Resilience

Abstract Background Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot.Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani-Score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani-Score). Therefore, we wanted to investigate weather the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter.Methods: To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting.Results High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63) and mental resilience (M = 2.25). During treatment, mental resilience improved (p = 0.015) significantly. The Spearman correlation coefficient between Pirani-Score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected.Conclusion The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.

Early Radiographic Changes in the Lateral Talocalcaneal Angle Following Achilles Tenotomy in Children With Idiopathic Clubfoot

2019 ◽  
Vol 41 (3) ◽  
pp. 350-355
Author(s):  
Jingchun Li ◽  
Yuanzhong Liu ◽  
Yiqiang Li ◽  
Zhe Yuan ◽  
Hongwen Xu ◽  
...  
Keyword(s):  
Correlation Coefficients ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Neutral Position ◽  
Level Of Evidence ◽  
Positive Correlation ◽  
Achilles Tenotomy ◽  
Severity Of The Disease ◽  
The Relationship ◽  
Radiographic Changes

Background: Percutaneous Achilles tenotomy (PAT) is an important component of the Ponseti method and is performed in 85% to 90% of patients. However, there is a lack of objective data assessing early radiographic changes in children undergoing PAT. Methods: Forty-nine patients with idiopathic clubfoot treated by Ponseti casting were prospectively enrolled between October 2017 and October 2018. Preoperative and postoperative ankle dorsiflexion (pre-ADFmax, post-ADFmax) and lateral talocalcaneal angle (pre-LTCAmax, post-LTCAmax) values with the ankle in maximal dorsiflexion as well as postoperative LTCA values with the ankle in the neutral position (post-LTCAneutral) were measured. The relationship between the preoperative and postoperative ADF and LTCA values was studied using Pearson or Spearman correlation coefficients. Forty-nine patients (72 feet) were included; the mean age at initial treatment was 32.2 ± 24.1 days. Results: Post-LTCAmax improved significantly from 18.6 ± 9.2 degrees to 25.1 ± 10.5 degrees ( P < .0001). Pre-ADF and pre-LTCAmax showed a positive correlation in both the less than 28-day group ( r = 0.42; P = .015) and the Dimeglio III group ( r = 0.29; P = .035). However, post-ADF and post-LTCAmax showed a positive correlation in the Dimeglio III group ( r = 0.30; P = .028). The degree of improvement in post-LCTAmax in the Dimeglio III group was similar to that in the Dimeglio IV group ( P = .28). Conclusion: The LTCA increased immediately after PAT in clubfoot, although the improvement seemed to be unrelated to the severity of the disease. PAT led to an increase in both ADF and the LTCA, and it contributed to the improvements in subtalar joint motion and alignment. Level of Evidence: Level III, comparative study.

scholarly journals Percutaneous heel cord release for clubfoot: a retrospective, multicentre cost analysis

2018 ◽  
Vol 12 (3) ◽  
pp. 273-278 ◽  
Author(s):  
B. Hedrick ◽  
F. K. Gettys ◽  
S. Richards ◽  
R. D. Muchow ◽  
C.-H. Jo ◽  
...  
Keyword(s):  
Operating Room ◽  
Outpatient Clinic ◽  
Perioperative Complications ◽  
Ponseti Method ◽  
Hospital Charges ◽  
Idiopathic Clubfoot ◽  
Achilles Tenotomy ◽  
Event Time ◽  
Serial Casting ◽  
Total Event

Purpose The Ponseti method of treatment is the standard of care for idiopathic clubfoot. Following serial casting, percutaneous tendo-Achilles tenotomy (TAT) is performed to correct residual equinus. This procedure can be performed in either the outpatient clinic or the operating room. The purpose of this study was to evaluate the expense of this procedure by examining hospital charges in both settings. Methods We retrospectively reviewed charts of 382 idiopathic clubfoot patients with a mean age of 2.4 months (0.6 to 26.6) treated with the Ponseti method at three institutions. Patients were divided into three groups depending on the setting for the TAT procedure: 140 patients in the outpatient clinic (CL), 219 in the operating room with discharge following the procedure (OR) and 23 in the operating room with admission to hospital for observation (OR+). Medical records were reviewed to analyze age, deformity, perioperative complications and specific time spent in each setting. Hospital charges for all three groups were standardized to one institution’s charge structure. Results Charges among the three groups undergoing TAT (CL, OR, OR+) were found to be significantly different ($3840.60 versus $7962.30 versus $9110.00, respectively; p ≤ 0.001), and remained significant when separating unilateral and bilateral deformities (p < 0.001). There were nine total perioperative complications (six returns to the ER and three unexpected admissions to the hospital): five (2.3%) in the OR group, four (17.4%) in the OR+ group and none in the CL group. The OR+ group statistically had a higher rate of complications compared with the other two groups (p = 0.006). The total event time of the CL group was significantly shorter compared with the OR and OR+ groups (129.1, 171.7 and 1571.6 minutes respectively; p < 0.001). Conclusion Hospital charges and total event time were significantly less when percutaneous TAT was performed in the outpatient clinic compared with the operating room. In addition, performing the procedure in clinic was associated with the lowest rate of complications. Level of Evidence Therapeutic, Level III

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