Comparison betweenTenotomy and Sliding of TendoAchillis in Infants UnderPonseti Treatment

Abstract

Background: Ponseti method is the gold standard for treating clubfoot. Persistent equinus component sometimes requires adding Achilles tendon surgery to the serial manipulation and casting technique. The various methods for achieving this tendon release are yet to be appraised.
Objective: Comparison between complete tenotomy and sliding technique regarding the degree of correction of equinus deformity at the end 6 months follow-up in infants less than 1 year of age undergoing serial manipulation and casting for Talipesequinovarus.
Methods: During the period from January 2008 to July 2011 48 feet in 36 infant under 1 year with clubfeet undergoing Ponseti Manipulative treatment were subjected to tendo Achillis surgery to correct the persistent equinus deformity. Complete tenotomy was performed in 24 (50%) and sliding technique done for 24 (50%) of the feet. Correction of hindfoot equines was appraised at the end of 6 months follow up period.
Results: Optimum dorsiflexion of 15° or more was obtained in 20 (83.3%) infants treated with tenotomy and in 18 (75%) infants treated with tendon sliding. Unsatisfactory dorsiflexion of less than 0* was present in 1 (4.2%) infant in both groups. Intermediate results considered when dorsiflexion between 0-15° was possible and was the sequelea of 3 (12.5%) tenotomies and 5 (20.8%) sliding operations.
Conclusion: Tenotomy and sliding technique are good or satisfactory in 95.8% of the feet.
Tenotomy in younger infants was foundtechnically more convenient.