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.

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 non-tenotomy 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.