Background: Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. Nevertheless, this possible underlying mechanism behind recurrences 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 Ponseti method. Methods: A retrospective chart review was performed on 20 children (14 boys, 6 girls; mean age: 7 years; age range: 5-9) 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 ultrasonographically measured. Results: The plantar flexion/dorsiflexion ratio was lower on the involved side (p = 0.001). No significant differences in the strength ratio of inversion/eversion were found (p = 0.4). No difference was observed in lengths of tibialis anterior and posterior tendon (p = 0,1), but Achilles tendon was longer on the involved side (p = 0.001; p < 0.01). A significant negative correlation was discovered between involved/uninvolved Achilles tendon length ratios and involved/uninvolved plantar flexion strength ratios (r = −0.524; p = 0.02) Conclusions: Achilles tendon elongation may be a contributor to the muscle imbalance in clubfeet with the relapsed forefoot adduction treated by the Ponseti technique.
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.
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.
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.
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.
Background: The Feet for Walking clubfoot project from Australia formally introduced the Ponseti technique in Vietnam in 2004 and is based at the Da Nang Orthopedic and Rehabilitation Centre in central Vietnam.
Methods: We provide an initial overview of the management of infant clubfoot deformity using the nonsurgical Ponseti method.
Results: Early indicators of the outcome of implementing this clubfoot project are largely positive but also require ongoing review. Further analyses of the use of the Ponseti method (or obstacles preventing the same) following training of personnel is underway.
Conclusions: Recent research has improved and refined the technique that must now be both appreciated and incorporated by clinicians. This technique is used across the world in both developed and developing countries and is universally regarded as the best management method for clubfoot deformities. (J Am Podiatr Med Assoc 99(4): 306–316, 2009)