Achilles tendon surgery in clubfoot: Are long term sequelae predictable?

Abstract

Congenital Clubfoot (CCF) treatment involves a surgical procedure on the Achilles tendon most of the time, i.e. tenotomy or, in selected cases, Z-plasty lengthening. Many authors have studied the outcomes of Achilles tenotomy, describing complete clinical and ultrasound tendon fibers integrity restoration 3-6 weeks after surgery. Nevertheless, little is known about the mechanical properties of the operated tendon. Recently, cases of subcutaneous rupture of the Achilles tendon have been described in adolescents who practiced sports and who had undergone Achilles tenotomy for congenital clubfoot in childhood. Authors report two cases of atraumatic Achilles tendon injury (subcutaneous rupture and intratendinous ossification) in adult patients who had been treated for congenital clubfoot in childhood. In both cases, no causes determining the injury were identified; in the medical history there was a Z-plasty lengthening of the Achilles tendon, performed within the first year of life, which could be considered a predisposing factor. The usefulness of long-term monitoring of patients treated for CCF with surgical procedures on the Achilles tendon is therefore hypothesized, in order to promptly identify by symptoms, clinical pictures and ultrasound criteria, tendon suffering that may predispose subcutaneous rupture.

Sonographic Appearance of a Midportion Achilles Tendinopathy in an Adult Who Underwent Achilles Tenotomy for Clubfoot

“…2 Achilles intratendinous ossification is the only long-term complication described in the literature after undergoing Achilles tenotomy for congenital talipes equinovarus. 3 However, the posttenotomy tendon morphology with its striation pattern might be more prone to develop tendinopathy as well, according to the case reported in this article. This type of Achilles tendinopathy seems to respond well to standard tendinopathy treatments.…”

“…As a result, weight-bearing tolerance, mobility, and pain are generally improved 2 . Achilles intratendinous ossification is the only long-term complication described in the literature after undergoing Achilles tenotomy for congenital talipes equinovarus 3 . However, the posttenotomy tendon morphology with its striation pattern might be more prone to develop tendinopathy as well, according to the case reported in this article.…”

Delayed Achilles Tendon Rupture at 17 Years of Age After Treatment of Clubfoot with Ponseti Method

“…In both cases, intraoperative findings included a significant amount of scar tissue at the distal end of the tendon. Moreover, Pedrotti et al 17 and Manfreda et al 18 reported calcification and rupture of the Achilles tendon in adults with a history of treatment for clubfoot. Although these cases differed from the present case in that they had previously undergone more invasive surgery, we believe that the pathophysiology of calcification and rupture because of degeneration of the Achilles tendon is similar to that of the present case.…”