Ultrasonographic Evaluation of Achilles Tendons in Clubfeet before and after Percutaneous Tenotomy

Agarwal, Anil; Qureshi, Nadeem Akhtar; Kumar, Pawan; Garg, Amit; Gupta, Neeraj

doi:10.1177/230949901202000114

Cited by 19 publications

(26 citation statements)

References 14 publications

(15 reference statements)

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“…Various studies have done to evaluate the endoachilles regeneration using USG and MRI; they noted that there is continuity of Achilis tendon from 3-12 weeks after the tenotomy. 9,11,12 Number of weeks after which the patient started walking and standing on tip toe after removal of the final cast was highest in previously operated patients, lesser in patients who were treated conservatively previously and least in neglected patients. It also increased as the age increased.…”

Section: 13mentioning

confidence: 99%

“…Tendoachilles regeneration after tenotomy has been confirmed on USG and MRI in children below 2 years of age but none of the studies have done functional evaluation of tendoachilles. [9][10][11][12] This study has been done to evaluate functional outcome of Tendoachilles following Ponseti's Tenotomy for treatment of Congenital Talipes Equino Varus in children older than 2 years and to assess the influence of age/previous treatment on the functional outcome of tendoachilles after tenotomy.…”

mentioning

confidence: 99%

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Functional outcome of tendoachilles following Ponseti’s tenotomy for treatment of congenital talipes equino varus in children older than two years

et al. 2017

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Background: Long term results of tenotomy and Ponseti technique are established worldwide. However, functions of Tendoachilles following Ponseti’s tenotomy in these cases i.e. idiopathic/neglected/operated/relapsed clubfeet (after casting or surgical correction) are not established. Tendoachilles regeneration after tenotomy has been confirmed on USG and MRI but only a few studies have done functional evaluation of tendoachilles. This study was done to evaluate the functional outcome of tendoachilles after tenotomy in patients older than two years presenting with CTEV. This study also assessed the influence of age and any previous treatment on tenotomy.Methods: In this study, 42 children (68 clubfeet) were seen in the two year study period. Children between 2-13 years coming to the outpatient department for treatment using the Ponseti’s method were followed during and after completion of treatment for 2 years. Patients were divided into two groups-first according to age and second according to previous treatment. Clinical evaluation of tendoachilles regeneration was done by evaluating the child’s ability to stand on tip of toes on single leg and walking ability.Results: The ability to stand on tip of toes after removal of the final cast was delayed maximum in the previously operated patients (9.5 weeks), lesser in patients who were previously treated by casting (7.3 weeks) and least in neglected patients (7 weeks). It also increased as the age increased (2-5 years age group required 7.4 weeks whereas 11-13 years age group required 16 weeks). Neglected patients started walking earlier (4.6 weeks) as compared to patients treated conservatively (4.8 weeks) or operatively (7.2 weeks). Younger children started walking earlier (age 2-5 years required 4.7 weeks whereas 11-13 years age group required 12 weeks). Conclusions: Functional evaluation of tendoachilles showed that all children who had tenotomy could walk and stand on tip of toes irrespective of age and previous treatment. However, older child and children having history of previous treatment, required longer time for recovery.

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Section: 13mentioning

confidence: 99%

mentioning

confidence: 99%

Functional outcome of tendoachilles following Ponseti’s tenotomy for treatment of congenital talipes equino varus in children older than two years

et al. 2017

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“…Although orthopedic surgeons agreed that initial treatment for clubfoot should be a conservative method to correct the clubfoot successfully [17, 22–27], the relapses, partial correction of clubfoot- rocker bottom foot is still not avoidable [28, 29]. Based on the literature search, in the past five decades, a number of studies have reviewed and published which include the history of development of conservative method and its management in the clubfoot [30, 31], controversies in the clubfoot management [32], current updates of clubfoot treatment and effectiveness of Ponseti method [1, 33, 34], different types of conservative methods (Ponseti techniques, Kite’s method, and French physical therapy method) and results of Ponseti methods [35], using sonography for the evaluation of clubfoot treatment outcome [36]. For a period of century, to the best of our knowledge, there were only 5 systematic review articles published on the clubfoot with related Ponseti management [37–41] and one as Cochrane review [42], in which Smythe, Kuper (41).…”

Section: Introductionmentioning

confidence: 99%

Ponseti method in the management of clubfoot under 2 years of age: A systematic review

et al. 2017

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BackgroundCongenital talipes equinovarus (CTEV), also known as clubfoot, is common congenital orthopedic foot deformity in children characterized by four components of foot deformities: hindfoot equinus, hindfoot varus, midfoot cavus, and forefoot adduction. Although a number of conservative and surgical methods have been proposed to correct the clubfoot deformity, the relapses of the clubfoot are not uncommon. Several previous literatures discussed about the technical details of Ponseti method, adherence of Ponseti protocol among walking age or older children. However there is a necessity to investigate the relapse pattern, compliance of bracing, number of casts used in treatment and the percentages of surgical referral under two years of age for clear understanding and better practice to achieve successful outcome without or reduce relapse. Therefore this study aims to review the current evidence of Ponseti method (manipulation, casting, percutaneous Achilles tenotomy, and bracing) in the management of clubfoot under two years of age.Materials and methodsArticles were searched from 2000 to 2015, in the following databases to identify the effectiveness of Ponseti method treatment for clubfoot: Medline, Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, and Scopus. The database searches were limited to articles published in English, and articles were focused on the effectiveness of Ponseti method on children with less than 2 years of age.ResultsOf the outcome of 1095 articles from four electronic databases, twelve articles were included in the review. Pirani scoring system, Dimeglio scoring system, measuring the range of motion and rate of relapses were used as outcome measures.ConclusionsIn conclusion, all reviewed, 12 articles reported that Ponseti method is a very effective method to correct the clubfoot deformities. However, we noticed that relapses occur in nine studies, which is due to the non-adherence of bracing regime and other factors such as low income and social economic status.

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“…These measurements were done based on the ultrasonography evidence of continuity of tendon which has been demonstrated within 3-6 weeks after tenotomy. 8,9 Clinical assessment of hindfoot correction was done using the established hindfoot Pirani score and measurement of the ankle dorsiflexion. Passive ankle dorsiflexion was done by applying pressure over the head of metatarsals and the quantitative measurement was done using goniometer.…”

Section: Methodsmentioning

confidence: 99%

A comparison study on hindfoot correction, Achilles tendon length and thickness between clubfoot patients treated with percutaneous Achilles tendon tenotomy versus casting alone using Ponseti method

Chandirasegaran

Gunalan

Saw

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: To compare the hindfoot correction using clinical and ultrasonography assessment in clubfoot patients undergoing Achilles tendon tenotomy with patients corrected with casting alone. Method: A prospective observational study on idiopathic clubfoot patients less than 3 months old. Clinical assessment was done using hindfoot Pirani score and measurement of ankle dorsiflexion. Serial ultrasonography was done to measure the length and thickness of the Achilles tendon pre-hindfoot correction, 3 and 6 weeks post-hindfoot correction. Independent t-test was used to analyse the increase in ankle dorsiflexion, improvement in length and thickness of Achilles tendon between the two groups. Mann-Whitney U test was used to analyse the improvement in hindfoot Pirani score. Pearson correlation test was used for correlation in between clinical severity and ultrasonography assessment. Results: Twenty-three patients with bilateral clubfoot and four with unilateral clubfoot were recruited with a total of 50 clubfeet. Each group consists of 25 feet with a mean age of 2 months. Marked improvement in hindfoot correction was noted in tenotomy group compared to nontenotomy group as evidenced by significant increase in Achilles tendon length, ankle dorsiflexion and improvement of hindfoot Pirani score. No significant difference in Achilles tendon thickness was noted between the two groups. Positive correlation was demonstrated between increase in Achilles tendon length and increase in ankle dorsiflexion as well as improvement in hindfoot Pirani score. Conclusion: We would like to propose Achilles tendon tenotomy in all clubfoot patients as it is concretely evident that superior hindfoot correction was achieved in tenotomy group.

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Ultrasonographic Evaluation of Achilles Tendons in Clubfeet before and after Percutaneous Tenotomy

Abstract: The study reasserts functional continuity of the Achilles tendons 4 weeks after tenotomy using clinical and ultrasonographic methods.

Cited by 19 publications

References 14 publications

Functional outcome of tendoachilles following Ponseti’s tenotomy for treatment of congenital talipes equino varus in children older than two years

Functional outcome of tendoachilles following Ponseti’s tenotomy for treatment of congenital talipes equino varus in children older than two years

Ponseti method in the management of clubfoot under 2 years of age: A systematic review

A comparison study on hindfoot correction, Achilles tendon length and thickness between clubfoot patients treated with percutaneous Achilles tendon tenotomy versus casting alone using Ponseti method

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