• 1.

    Ponseti IV: Treatment of congenital club foot. J Bone Joint Surg Am 74: 448, 1992.

  • 2.

    Dobbs MB & Gurnett CA: Update on clubfoot: etiology and treatment. Clin Orthop Relat Res 467: 1146, 2009.

  • 3.

    Foster A & Davis N: Congenital talipes equinovarus (clubfoot). Surgery 25: 171, 2007.

  • 4.

    Morcuende JA, Dobbs MB & Frick SL: Results of the Ponseti method in patients with clubfoot associated with arthrogryposis. Iowa Orthop J 28: 22, 2008.

  • 5.

    Adegbehingbe OO, Oginni LM & Ogundele OJ et al.: Ponseti clubfoot management: changing surgical trends in Nigeria. Iowa Orthop J 30: 7, 2010.

  • 6.

    Laaveg SJ & Ponseti IV: Long-term results of treatment of congenital club foot. J Bone Joint Surg Am 62: 23, 1980.

  • 7.

    Maranho DA, Nogueira-Barbosa MH & Simão MN et al.: Ultrasonographic evaluation of Achilles tendon repair after percutaneous sectioning for the correction of congenital clubfoot residual equinus. J Pediatr Orthop 29: 804, 2009.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 8.

    Mangat KS, Kanwar R & Johnson K et al.: Ultrasonographic phases in gap healing following Ponseti-type Achilles tenotomy. J Bone Joint Surg Am 92: 462, 2010.

    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 9.

    Niki H, Nakajima H & Hirano T et al.: Ultrasonographic observation of the healing process in the gap after a Ponseti-type Achilles tenotomy for idiopathic congenital clubfoot at two-year follow-up. J Orthop Sci 18: 70, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 10.

    Agarwal A, Qureshi NA & Kumar P et al.: Ultrasonographic evaluation of Achilles tendons in clubfeet before and after percutaneous tenotomy. J Orthop Surg 20: 71, 2012.

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 11.

    Anipole OA, Adegbehingbe OO & Ayoola O: Confirmation of tenotomy healing at 3 weeks using the Ponseti protocol. J Foot Ankle Surg 59: 529, 2020.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 12.

    Lebel E, Karasik M & Bernstein-Weyel M et al.: Achilles tenotomy as an office procedure: safety and efficacy as part of the Ponseti serial casting protocol for clubfoot. J Pediatr Orthop 32: 412, 2012.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 13.

    Burghardt RD, Herzenberg JE & Ranade A: Pseudoaneurysm after Ponseti percutaneous Achilles tenotomy: a case report. J Pediatr Orthop 28: 366, 2008.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 14.

    Changulani M, Garg N & Bruce CE: Neurovascular complications following percutaneous tendoachillis tenotomy for congenital idiopathic clubfoot. Arch Orthop Trauma Surg 127: 429, 2007.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 15.

    Dobbs MB, Gordon JE & Walton T et al.: Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. J Pediatr Orthop 24: 353, 2004.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Bleakney RR & White LM: Imaging of the Achilles tendon. Foot Ankle Clin 10: 239, 2005.

  • 17.

    MacNeille R, Hennrikus W & Stapinski B et al.: A mini-open technique for Achilles tenotomy in infants with clubfoot. J Child Orthop 10: 19, 2016.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 18.

    Adewole A, Williams OM & Shoga MO et al.: Experience with Ponseti protocol and achilles tenotomy in the management of clubfoot at the Lagos State University Teaching Hospital, Lagos, Nigeria. J West Afr Coll Surg 7: 65, 2017.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Gupta GK, Rani S & Sahu C et al.: Redevelop of Achilles tendon after percutaneous tenotomy in idiopathic clubfoot patients as per Ponseti's method of correction clinically and using two needle. Int J Recent Sci Res 6: 5665, 2015.

    • Search Google Scholar
    • Export Citation
  • 20.

    Kumar R & Priya A: Management of idiopathic clubfoot by Ponseti's method: a comparative clinical study on toddlers with radiological correlation. Int J Res Orthop 2: 52, 2016.

    • Search Google Scholar
    • Export Citation
  • 21.

    Ippolito E, De Maio F & Mancini F et al.: Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired? J Child Orthop 3: 171, 2009.

  • 22.

    Benjamin M, Theobald P & Suzuki D et al.: “The Anatomy of the Achilles Tendon,” in The Achilles Tendon , ed by Maffulli, N & Almekinders, L p 5, Springer-Verlag, London, 2007.

    • Search Google Scholar
    • Export Citation
  • 23.

    Bezerra RFA, Campos JD & Bezerra VLVA et al.: Measurements of the calcaneal tendon in the first year of life. Radiol Bras 42: 141, 2009.

  • 24.

    de Mello RAF, Marchiori E & dos Santos AASMD et al.: Morphometric evaluation of Achilles tendon by ultrasound. Radiol Bras 39: 61, 2006.

  • 25.

    Koivunen-Niemelä T & Parkkola K: Anatomy of the Achilles tendon (tendo calcaneus) with respect to tendon thickness measurements. Surg Radiol Anat 17: 263, 1995.

Determination of the Effective Site for Percutaneous Achilles Tenotomy in Ponseti Management of African Idiopathic Clubfoot

Restricted access

Background

Percutaneous Achilles tenotomy is an essential step in the Ponseti treatment of idiopathic clubfoot, with reported complications such as injury to the surrounding neurovascular structures and incomplete division of the Achilles tendon (AT). Knowledge of AT thickness would guide tenotomy blade insertion depth, obviating these related complications. We embarked on this study to ultrasonographically determine AT thickness at its different levels from the calcaneal insertion in children with idiopathic clubfoot.

Methods

This prospective comparative study consisted of two groups of children 4 years and younger: a study group of patients with clubfoot requiring tenotomy and a control group. Both groups underwent ultrasonographic evaluation of their AT. The ultrasonographic data collected include AT thickness 1 and 2 cm from the calcaneal insertion of the AT, thickness of the thinnest portion of the tendon, and the distance of this thinnest portion from the calcaneal insertion.

Results

Twenty-seven children with idiopathic clubfoot constituted the study group, and 23 children with no musculoskeletal deformity were enrolled in the control group. Mean ± SD AT thicknesses 1 and 2 cm from the calcaneal insertion in the study group were 2.4 ± 0.7 mm and 2.1 ± 0.7 mm, respectively, and in the control group were 2.5 ± 0.7 mm and 2.3 ± 0.7 mm, respectively. The average thickness of the thinnest portion of the AT along its length was 2 mm at 1.8 cm from the calcaneal insertion in both groups.

Conclusions

Safe and complete percutaneous tenotomy would most likely be achieved when performed 1.8 cm from the calcaneal insertion, where the corresponding average AT thickness of 2 mm would be a guide to determine the insertion depth of the tenotomy blade.

Department of Orthopaedics, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria.

Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.

Department of Radiology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.

Department of Surgery, Federal Medical Centre, Keffi, Nasarawa State, Nigeria.

Corresponding author: Olalekan A. Anipole, MBBS, Department of Orthopaedics, Federal Medical Centre, along Dukku Barrack Road, Birnin Kebbi, P.M.B 1126 Kebbi State, Nigeria (E-mail: anipoleola@gmail.com)