Achilles Tendon Release in Clubfoot: Radiological Comparison of Needle and Scalpel Techniques

BACKGROUND Achilles tenotomy is the final and most critical step of the Ponseti method for correcting equinus deformity in idiopathic congenital talipes equinovarus (CTEV). The procedure can be performed using either a needle or a scalpel; however, it remains uncertain whether these 2 percutaneous techniques provide different levels of tendon relaxation and radiological correction. MATERIAL AND METHODS This retrospective study included 130 feet of 90 patients with CTEV treated by the Ponseti method between January 2022 and December 2024. Patients underwent percutaneous Achilles tenotomy either with a 16-gauge needle under topical anesthesia or with a No. 15 scalpel blade under general anesthesia. Only patients with at least 1 year of follow-up were included. Lateral foot radiographs obtained in maximum dorsiflexion at 1 year postoperatively were used to measure the tibiocalcaneal, talocalcaneal, and talo-first metatarsal angles. Maximum ankle dorsiflexion was measured with a goniometer. The results were compared between the 2 tenotomy groups and with the unaffected feet of the same patients. RESULTS No significant differences were observed between the needle and scalpel groups in any radiological parameter or in maximum dorsiflexion (P>0.05). Compared with the unaffected feet, the tibiocalcaneal angle was significantly higher (P<0.001), while the talocalcaneal angle was significantly lower (P<0.001), in both tenotomy groups. The talo-first metatarsal angle showed no significant difference (P=0.099). CONCLUSIONS The 2 techniques - percutaneous Achilles tenotomy with a needle and with a scalpel - provided comparable radiological and functional outcomes. Although clinical correction is satisfactory, persistent differences in tibiocalcaneal and talocalcaneal angles suggest that mild structural deviations may remain despite successful treatment.