Does the percutaneous Achilles tenotomy in clubfoot treatment objectively modify the equinus

1
Does the percutaneous Achilles tenotomy in
clubfoot treatment objectively modify the equinus
?

• G.Grimard, MD FRCS(C), B.Morin, MD FRCS(C)
• M.-A. Cantin, MD FRCS(C), M.Duhaime, MD FRCS(C)
• Hôpital Sainte-Justine, University of Montreal
• Montreal, CANADA

Sorrento IFPOS/EPOS 2007
2
Introduction

• In the course of Ponsetis technique for the
  treatment of idiopathic clubfoot, an Achilles
  tenotomy is suggested following correction of the
  other deformities to improve dorsal flexion.
• However, no study or report has been published to
  confirm the effect of the tenotomy.

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AIM

• The purpose of this study was to determine the
  immediate effect of Achilles tenotomy on the
  tibio-calcaneal (TC) and tibio-foot (TF) angles
  performed in the course of clubfoot treatment
  according to the Ponseti method.

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Materials and Methods

• This prospective study was carried out at the
  Ste-Justine University Hospital Clubfoot Clinic
  between July 2005 and August 2006.
• All patients newly enrolled in the treatment
  course of idiopathic clubfoot according to the
  Ponseti method were included.
• More specifically, the inclusion criteria were
• a diagnostic of idiopathic clubfoot
• a residual equinus or a dorsal flexion lt 10
• a minimum of 4 weeks of serial casting with a
  correction of the other deformities.

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Materials and Methods

• A percutaneous Achilles tenotomy was performed
  under local anesthesia.
• Before and immediately after the tenotomy, a
  lateral X-ray of the foot with maximal dorsal
  flexion of the ankle was obtained using a mini
  C-arm fluoroscope. All the X-ray images were
  stored on the PACS (Picture Archiving and
  Communication System) and measured independently
  by two observers.
• After surgery, a long leg cast was applied for
  2-4 weeks.

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Materials and Methods

• Two measures were assessed, the tibio-calcaneal
  (TC) and the tibio-foot (TF) angles,
  respectively.
• A two-tailed paired-t test was used to compare
  pre and post-tenotomy measurements.

58
72
Lateral X-ray pre-tenotomy
Lateral X-ray post-tenotomy
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Results

• Thirty-four clubfeet in 23 patients were enrolled
  in the study
• (bilateral in 48).
• There were 17 males and 6 females.
• The right foot was involved in 17 cases.
• The mean age at the tenotomy was 50.7 days 16.6
  days.

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Results

• No complication was associated with the tenotomy.

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Discussion

• This is the first study to investigate the
  immediate effect of Achilles tenotomy early in
  the course of the treatment of idiopathic
  clubfoot.
• Although the procedure does not work in all
  infants, it was effective in most.
• This study confirms the important role of the
  Achilles tendon as the main structure preventing
  the dorsal flexion.
• Finally, the procedure is safe and easy to
  perform at the outpatient clinic under local
  anesthesia.

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Conclusion

• Percutaneous Achilles tenotomy performed in the
  initial stage (3-8 weeks) of the treatment of
  clubfoot immediately improves both clinical and
  radiological equinus in idiopathic clubfoot.
• According to the results of this study, we
  recommend to maintain this practice.

Thank you