FREQUENCY OF ACHILLES TENOTOMY IN PATIENTS WITH CONGENITAL TALIPES EQUINOVARUS (CTEV), AFTER TREATMENT WITH PONSETI SERIAL CASTS
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Keywords
infants, Achilles tenotomy, Ponseti serial casting, equinus deformity, club foot
Abstract
Background: Congenital Talipes Equinovarus (CTEV), often known as congenital clubfoot, is a common musculoskeletal birth condition that affects 1–2 per 1,000 live births. It is more common in male children, with a 2.5:1 male to female ratio, and almost half of all instances involve both feet. The percutaneous Achilles tenotomy is a critical step in the Ponseti approach, as it is frequently required to address chronic equinus deformity after addressing forefoot and midfoot abnormalities. The frequency of this treatment ranges from 60 to 90%, which contributes to the Ponseti technique's overall success rate of 95%.
Objective: To determine the frequency of Achilles tenotomy in children with congenital talipes equinovarus who are treated with Ponseti serial casts.
Study design: A cross-sectional Study
Place and Duration: This study was conducted in Shaheed Mohtarma Benazir Bhutto Medical University Hospital Larkana from November 2022 to November 2023
Methodology: This study included all infants, regardless of gender, and children up to the age of two years who presented with idiopathic clubfoot to the Orthopedic Outpatient Department. The severity of clubfoot was determined by Pirani grading, which ranged from 0 to 6, with 6 signifying severe deformity. Ponseti serial casting was done weekly. Brace treatment began without tenotomy if, upon casting, there was no residual equinus deformity. For infants who met certain requirements, a final two-week cast was applied after a percutaneous Achilles tenotomy performed under local anesthesia.
Results: There were a total of 80 children who were a part of this study. All of the children had CTEV and they were included in this research for Ponseti serial casting. The average age was 10.3 weeks. The Pirani score at the starting was 3.74 while at the final stage, it was 1.74. The mean correction score was 5.84. There were no statistically significant changes in the frequency of Achilles tenotomy based on the affected limb's side, whether one or both limbs were implicated, initial Pirani score, age, gender, or number of casts. Furthermore, no problems were reported.
Conclusion: A considerable proportion of our children had persisting equinus deformity, which resulted in a high incidence of Achilles tenotomy after Ponseti serial casting.
Keywords: , ,, ,
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Mushtaque Ahmed Shaikh
Mushtaque Ahmed Shaikh, Assistant Professor Orthopaedics, Shaheed Mohtarma Benazir Bhutto Medical University Hospital Larkana Pakistan. Email: masortho@yahoo.com
Sijad Ahmed Mahar
Assistant Professor Orthopaedics, Ghulam Muhammad Mahar Medical College Sukkur Pakistan. Email: drsajjadsarwar@gmail.com
Niaz Hussain Keerio
Assistant Professor Orthopaedics, Muhammad Medical College , Ibn-E-Sina University Mirpurkhas Pakistan. Email: niaz_h@hotmail.com
Asif Ahmed Amin
Registrar Orthopaedics, Memon Medical Institute Hospital Karachi Pakistan. Email: asifahmedaminn@gmail.com
Azizullah Bhayo
Assistant Professor Orthopaedics, Ghulam Muhammad Mahar Medical College Sukkur Pakistan. Email: azizbhayo@gmail.com
Osama Bin Zia
Assistant Professor Orthopaedics, Liaquat College of Medicine and Dentistry, Darul Sehat Hospital Karachi Pakistan. Email: osama.zia@hotmail.com