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Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment
Christof Radler1, Hans Michael Manner, Renata Suda
1Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising-Vienna, Speisingerstrasse 109, 1130 Vienna, Austria. christof.radler@chello.at
Insights
Percutaneous Achilles tenotomy in the Ponseti method significantly increases ankle dorsiflexion, as confirmed by radiographs. This procedure provides true dorsiflexion in the ankle and hindfoot for treating idiopathic clubfeet.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Foot and Ankle Surgery
Background:
- The Ponseti method is a standard treatment for idiopathic clubfeet, utilizing serial casting, percutaneous Achilles tenotomy, and bracing.
- Radiographic evaluation is often used by surgeons, despite the Ponseti method's emphasis on clinical assessment.
- This study aimed to radiographically document the effects of percutaneous Achilles tenotomy within the Ponseti method.
Purpose of the Study:
- To radiographically assess the impact of percutaneous Achilles tenotomy on idiopathic clubfeet treated with the Ponseti method.
- To correlate radiographic findings with clinical measurements of ankle dorsiflexion post-tenotomy.
Main Methods:
- A retrospective study of 87 idiopathic clubfeet treated with the Ponseti method, including percutaneous Achilles tenotomy, across two centers.
- Radiographs (lateral and anteroposterior) were taken before and after tenotomy.
- Measurements included lateral tibiocalcaneal angle, anteroposterior talocalcaneal angle, lateral talocalcaneal angle, and clinical ankle dorsiflexion.
Main Results:
- A mean improvement of 16.9 degrees in the lateral tibiocalcaneal angle was observed post-tenotomy.
- Clinical dorsiflexion increased by a mean of 15.1 degrees.
- Only the lateral tibiocalcaneal angle and clinical dorsiflexion showed statistically significant changes (p < 0.05).
Conclusions:
- Radiographic findings support that percutaneous Achilles tenotomy yields true ankle and hindfoot dorsiflexion.
- The procedure effectively increases the lateral tibiocalcaneal angle and clinical ankle dorsiflexion.
- Talocalcaneal angles were not significantly affected by the tenotomy.
Background:
The Ponseti method for treatment of idiopathic clubfeet involves the use of serial casts, percutaneous Achilles tenotomy in most cases, and bracing with an abduction orthosis to prevent relapse. Although Ponseti recommended evaluation of the infant clubfoot strictly by palpation, many orthopaedic surgeons still rely on radiographs for decision-making during treatment. The aim of this study was to document with radiographs the effect of percutaneous Achilles tenotomy as described by Ponseti.
Methods:
We conducted a study of idiopathic clubfeet treated, at two centers, with the Ponseti method, including percutaneous Achilles tenotomy. Cast treatment was started within three weeks after birth, and radiographs were made before and after the tenotomy. Lateral radiographs with the foot in maximal dorsiflexion at the ankle were made for all patients, and anteroposterior radiographs of the foot were made at one center. The lateral tibiocalcaneal angle, the anteroposterior talocalcaneal angle, and the lateral talocalcaneal angle were measured on the radiographs. Foot dorsiflexion at the ankle was evaluated clinically. The results from both centers were evaluated separately and in combination.
Results:
Lateral dorsiflexion radiographs that showed the foot and ankle were evaluated for eighty-seven clubfeet, and anteroposterior radiographs that showed the foot were evaluated for sixty-five clubfeet. The mean improvement in the lateral tibiocalcaneal angle after the tenotomy was 16.9 degrees . The mean change in the anteroposterior talocalcaneal angle was 2.1 degrees , and the mean change in the lateral talocalcaneal angle change was 1.4 degrees . The mean increase in clinically measured dorsiflexion after the tenotomy (in sixty-five feet) was 15.1 degrees . Only the lateral tibiocalcaneal angle and dorsiflexion as measured clinically changed significantly after the Achilles tenotomy (p < 0.05). When the results at each center were analyzed separately, they were found to be nearly identical.
Conclusions:
The increase in the lateral tibiocalcaneal angle after Achilles tenotomy is essentially the same as the increase in ankle dorsiflexion seen on clinical examination. The anteroposterior and lateral talocalcaneal angles are not influenced significantly by the tenotomy. Radiographs confirmed that the additional dorsiflexion obtained from the percutaneous Achilles tenotomy is true dorsiflexion occurring in the ankle and hindfoot and not in the midfoot.
Level Of Evidence:
Therapeutic Level IV.
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