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Relationship Between Recurrent Adductus Deformity of the Forefoot and Achilles Tendon Elongation Following Ponseti Treatment in Children with Idiopathic Clubfoot

Mehmet DemirelOrthopedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.

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Fuat BilgiliOrthopedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.

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Çiğdem Özkara BilgiliRadiology, Bayrampasa State Hospital, Istanbul, Turkey.

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Serkan BayramOrthopedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.

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Ömer Naci ErginOrthopedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.

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Yener TemelliOrthopedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.

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Background: Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. However, this possible underlying mechanism behind recurrence has not been investigated sufficiently to date. This study aimed to explore whether there is a relationship between Achilles tendon elongation and recurrent metatarsus adductus deformity in children with unilateral clubfeet treated by the Ponseti method.

Methods: A retrospective chart review was performed on 20 children (14 boys and six girls; mean age, 7 years; age range, 5–9 years) with a recurrent metatarsus adductus deformity treated by the Ponseti method for unilateral idiopathic clubfoot. At the final follow-up, isometric muscle strength was measured using a portable, hand-held dynamometer in reciprocal muscle groups of the ankle. The length of the tendons around the ankle was measured ultrasonographically.

Results: The plantarflexion-to-dorsiflexion ratio was lower on the involved side (P = .001). No significant differences in the strength ratio of inversion to eversion were found (P = .4). No difference was observed in lengths of tibialis anterior and posterior tendons (P = .1), but the Achilles tendon was longer on the involved side (P = .001; P < .01). A significant negative correlation was discovered between involved-to-uninvolved Achilles tendon length ratios and involved-to-uninvolved plantarflexion strength ratios (r = –0.524; P = .02)

Conclusions: Achilles tendon elongation may be a contributor to the muscle imbalance in clubfeet with relapsed forefoot adduction treated by the Ponseti technique.

Corresponding author: Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Fatih, Istanbul, 34100 Turkey. (E-mail: dr88.mehmet.demirel@gmail.com)