Abstract

PERCUTANEOUS NEEDLE TENOTOMY FOR PONSETI MANAGEMENT OF IDIOPATHIC CONGENITAL TALIPES EQUINOVARUS

Mustafa Wameedh Ibrahim* and Ouday Falih Al-Ali

Abstract

Introduction: The Ponseti method has become a well-established method in treating congenital talipes equinovarus deformity. Achilles tenotomy is frequently needed as the final step in the method. Aim: to evaluate clinically the effectiveness of percutaneous tenotomy of Achilles tendon using an 18-gauge needle in idiopathic clubfoot treatment by Ponseti technique. Materials and Methods: A total number of 40 children with 50 idiopathic clubfeet were included in this study. All were treated by classic Ponseti method through serial stretching and casting. For residual equinus, tenotomy of Achilles tendon was performed using percutaneous needle tenotomy technique in 25 feet, and the classic blade tenotomy in the remaining 25 feet. Pirani scoring system was used to assess clubfoot deformity correction. Results: Mean age when treatment started was 9.44 weeks, and 15 weeks at time of tenotomy. Loss of control over the needle or blade during tenotomy was reported in 8% and 4% respectively without any serious consequences. Minor bleeding occurred in 8% of needle tenotomy in contrast to 16% of blade tenotomy feet. There was no incidence of infection, pseudoaneurysm nor neurovascular injury in any case from both groups. In term of deformity correction, between those treated with needle tenotomy and those treated with blade tenotomy as the rates of reasonable correction (Excellent and good results) were 100% and 96% respectively. Conclusions: Percutaneous Achilles tenotomy with a wide gauge needle is a simple, safe and effective technique. It yields similar correction rates with lower morbidity and carries lesser risk of complications compared to a surgical blade. The researcher highly recommends its use for as part of Ponseti method of clubfoot in infancy and early childhood.

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