Pseudoaneurysm After Ponseti Percutaneous Achilles Tenotomy

Abstract

The Ponseti method has become a popular technique to treat idiopathic clubfoot. In most cases, a percutaneous Achilles tenotomy is required to correct residual equinus contracture. Bleeding has been reported as a complication of percutaneous tenotomy. We present a case of a baby who developed a pseudoaneurysm after undergoing an appropriate Ponseti percutaneous Achilles tenotomy at the age of 8 weeks. The diagnosis of pseudoaneurysm was confirmed by color ultrasonography, which showed active flow in the base of the mass. This complication has not been previously described after Ponseti percutaneous Achilles tenotomy. The large pseudoaneurysm mass together with an incomplete correction made bracing with straight last shoes and Denis Browne bar impossible, and the patient developed an immediate relapse of the clubfoot deformity. The relapsed deformity was successfully treated with 4 weeks of additional Ponseti casting, with an emphasis on applying pressure over the pseudoaneurysm by molding the cast. Repeat ultrasonogram at that time showed that the pseudoaneurysm completely resolved, making invasive treatment of the pseudoaneurysm unnecessary. Physicians should be aware that vascular injury could lead to pseudoaneurysm after performing this otherwise simple office procedure.

A comparison of percutaneous and mini-open techniques of Achilles tenotomy: An experimental study in rats

“…For this purpose, blade modifications and different techniques of tenotomy were introduced in order to avoid any neurovascular injury [5,7]. Some authors recommended a small open incision to directly visualise the tendon before severing it to decrease the risk of neurovascular injury, but the results and the details of the technique are lacking [5,6].…”

“…Although percutaneous Achilles tenotomy is a relatively simple technique with low complication rates, articles reporting complications increases as the technique becomes more popular [5,6]. Recently, different tenotomy techniques and new designs of surgical blade modifications have taken place in the literature, in order to perform the technique in a safer fashion [5,7].…”

Pé torto congênito

“…71,[75][76][77][78] In these cases, the blood supply occurs separately through the fibular artery. 73 …”

“…These include excessive bleeding, attributed to lesion of the posterior fibular artery or saphenous vein 118 and formation of pseudoaneurysm. 73 Clinical studies with late follow-up showed that tenotomy does not cause late onset effects such as tendon weakening and ruptures. 53,60,113,120,121 Previous studies on other types of disease showed that there is complete repair of the calcaneal tendon after its total sectioning at the myotendineous junction 122 , or more distally.…”

“…14 The most frequent anomaly is absence or hypoplasia of the anterior tibial artery, which is present proximally in the leg, but ends abruptly in the ankle or in the calf, with deficient or absent anastomotic network. 14,[68][69][70][71][72][73] The absence of pedis pulse is more frequent in CC of greater severity and in older children. 74 In rarer situations, there can be more accentuated vascular insufficiencies, which also compromise the perfusion provided by the posterior tibial artery.…”