Foot (Edinburgh, Scotland) · 2026
Ideal location for Achilles tendon tenotomy following the Ponseti method for correction of clubfoot deformity: Results of MRI cohort in children 18 months old or younger.
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Meouchi Enrique Alberto Vargas, Lage Iker Benegas, Leiva Diego Bastian Soza, Riera Luis, Vicente Daniel Pacha, Rosell Carla Carbonell
Аннотация
OBJECTIVE: To determine the optimal anatomical location for performing Achilles tendon tenotomy in children under 18 months of age, using MRI measurements to enhance surgical safety and efficacy during the Ponseti method for clubfoot correction.
METHODS: A retrospective study was conducted of children aged 18 months or younger without clubfoot deformity who underwent MRI scans of the foot and ankle in our tertiary center from January 2012 to December 2023 for unrelated clinical indications. T1-weighted post-gadolinium images were analyzed to measure the medial distance between the Achilles tendon and the posterior tibial neurovascular bundle, as well as tendon width, at four levels: at the superior border of the calcaneus, and 10 mm, 20 mm, and 30 mm proximal. Measurements were performed independently by three orthopedic team members, and mean values were calculated.
RESULTS: Eleven patients were included in the final analysis. At the superior border of the calcaneus, the mean distance to the neurovascular bundle was 11.43 ± 1.54 mm, decreasing to 10.56 ± 2.17 mm at 10 mm, 8.39 ± 2.01 mm at 20 mm, and 7.10 ± 1.80 mm at 30 mm proximally. The Achilles tendon width was widest at the calcaneal border (11.33 ± 1.23 mm) and decreased significantly at more proximal levels.
CONCLUSION: Performing the tenotomy 10-20 mm proximal to the superior calcaneal border offers an optimal balance between tendon width and a safe distance from the posterior tibial neurovascular bundle. This location may reduce the risk of iatrogenic vascular injury during Ponseti treatment of clubfoot in infants.
METHODS: A retrospective study was conducted of children aged 18 months or younger without clubfoot deformity who underwent MRI scans of the foot and ankle in our tertiary center from January 2012 to December 2023 for unrelated clinical indications. T1-weighted post-gadolinium images were analyzed to measure the medial distance between the Achilles tendon and the posterior tibial neurovascular bundle, as well as tendon width, at four levels: at the superior border of the calcaneus, and 10 mm, 20 mm, and 30 mm proximal. Measurements were performed independently by three orthopedic team members, and mean values were calculated.
RESULTS: Eleven patients were included in the final analysis. At the superior border of the calcaneus, the mean distance to the neurovascular bundle was 11.43 ± 1.54 mm, decreasing to 10.56 ± 2.17 mm at 10 mm, 8.39 ± 2.01 mm at 20 mm, and 7.10 ± 1.80 mm at 30 mm proximally. The Achilles tendon width was widest at the calcaneal border (11.33 ± 1.23 mm) and decreased significantly at more proximal levels.
CONCLUSION: Performing the tenotomy 10-20 mm proximal to the superior calcaneal border offers an optimal balance between tendon width and a safe distance from the posterior tibial neurovascular bundle. This location may reduce the risk of iatrogenic vascular injury during Ponseti treatment of clubfoot in infants.