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

Abstract

Background: Percutaneous Achilles tenotomy is an integral component of congenital clubfoot treatment using the Ponseti method. This study was designed to assess the frequency and outcome of percutaneous Achilles tenotomy in the conservative treatment of congenital clubfoot by the Ponseti method.

Patients and methods: A prospective study of all congenital clubfoot patients between the ages of zero and two years who attended our clubfoot clinic between January, 2013 and December, 2017 was carried out. At presentation, each clubfoot was assessed clinically and scored using the Pirani scoring system, and treated using the Ponseti method. Percutaneous Achilles tenotomy was performed for feet with persistent equinus deformity. Statistical analysis of the distribution and associations of percutaneous Achilles tenotomy was done using IBM SPSS version 22 was done.

Results: A total of 97 patients with 147 clubfeet were studied. The median total Pirani score (TPS), midfoot contracture score (MFCS) and hindfoot contracture score (HFCS) at presentation were 4.5, 2.5 and 2.5 respectively. Percutaneous Achilles tenotomy was performed on 97 (66.4%) feet belonging to 63 patients. Eighty five out of 108 feet with initial total Pirani score of 3.0 and above required percutaneous Achilles tenotomy to achieve correction (p < 0.001).

Conclusion: Treatment of congenital clubfoot using the Ponseti method was associated with a tenotomy rate of 66.4%. High Pirani scores as well as increasing age at presentation were associated with the need for percutaneous Achilles tenotomy.

Keywords: Congenital, Clubfoot, Pirani scoring system, Ponseti method, Achilles tenotomy