Safety and Efficacy of Achilles Tenotomy under Local Anaesthesia: as Part of the Ponseti Clubfoot Management -Experience at the Sudan clubfoot clinic
Abstract
Introduction: Ponseti method of treatment of clubfoot is a gold standard method. It includes serial casting to be followed by percutaneous tenotomy of the Achilles tendon under local anaesthesia. In the current study the safety and efficacy of tenotomy under local anaesthesia following serial casting will be studied.
Patients and Methods: 89 patients who were seen at the Sudan Clubfoot clinic at Soba University Hospital between 2011 and 2012. All underwent serial casting according to Ponseti method and that was followed by Achilles tenotomy under local anaesthesia using a single stab using a size 15 scalpel.
Results: there were 89 patients (135 feet), 64 [71.9%] males and 25 (28.1%) females. 46 patients (51.1%) had bilateral involvement. Familial history was there in 11 (11.2%) babies. Tenotomy was performed in all feet after an average of 6.2 casts (range, 3 to 11). All were discharged 2 hours after the tenotomy. No adverse events were related to local anaesthesia and/or the procedure itself, and there was no delay in discharge in any of the operated babies. All patients had an uneventful course. Only one patient (1.12%) had previous conservative treatment before coming to the clinic. Pressure sores were observed as a result of casting in one foot. Residual equinus deformity after the tenotomy was experienced in 5 feet. 86 of the parents were satisfied with the correction. The rest; 3 patients (3.37%) were not satisfied because of the residual equinus.
Conclusion: Tenotomy procedure using local anaesthesia is an effective and safe procedure.
References
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2.Ponseti IV. Treatment of congenital club foot. The Journal of bone and joint surgery American volume. 1992;74(3):448-54. Epub 1992/03/01.
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4.Ippolito E, Fraracci L, Farsetti P, Di Mario M, Caterini R. The influence of treatment on the pathology of club foot. CT study at maturity. The Journal of bone and joint surgery British volume. 2004;86(4):574-80. Epub 2004/06/04.
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6.Scher DM, Feldman DS, van Bosse HJ, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. Journal of pediatric orthopedics. 2004;24(4):349-52.
7.Lykissas MG, Crawford AH, Eismann EA, Tamai J. Ponseti method compared with soft-tissue release for the management of clubfoot: A meta-analysis study. World journal of orthopedics. 2013;4(3):144-53. Epub 2013/07/24.
8.Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. The Journal of bone and joint surgery American volume. 1980;62(1):23-31. Epub 1980/01/01.
9.Patwardhan PS, A. and Sancheti, P. Percutaneous Needle Tenotomy for Tendo-achillis Release in Clubfoot – Technical Note. J Orthopaedic case reports. 2012;2(1):35 -6.
10.Bor N, Coplan JA, Herzenberg JE. Ponseti treatment for idiopathic clubfoot: minimum 5-year followup. Clinical orthopaedics and related research. 2009;467(5):1263-70.
11.Mohan SM, Pawan, T., Mohan, S.S., Madhu, M.T. Modified Ponseti Technique for theManagement of Congenital Talipes Equino Varus (CTEV) in Neonates: Our Experience in a Rural Teaching Institution. Journal of Evolution of Medical and Dental Sciences. 2014;3(14):3618 - 26.
12.Hootnick DR, Packard DS, Jr., Levinsohn EM, Crider RJ, Jr. Confirmation of arterial deficiencies in a limb with necrosis following clubfoot surgery. Journal of pediatric orthopedics Part B. 1999;8(3):187-93. Epub 1999/07/10.
13.Bitariho D. Short-term outcome in one stage pantalar soft-tissue release with transfixation of talonavicular joint in resistant idiopathic congenital clubfoot. Unpublished: Makerere University); 2001.
14.Cowell HR, Wein BK. Genetic aspects of club foot. The Journal of bone and joint surgery American volume. 1980;62(8):1381-4.
15.Yamamoto H. A clinical, genetic and epidemiologic study of congenital club foot. Jinrui idengaku zasshi. 1979;24(1):37-44.
16.Dobbs MB, Morcuende JA, Gurnett CA, Ponseti IV. Treatment of idiopathic clubfoot: an historical review. The Iowa orthopaedic journal. 2000;20:59-64.
17.Lebel E, Karasik M, Bernstein-Weyel M, Mishukov Y, Peyser A. Achilles tenotomy as an office procedure: safety and efficacy as part of the Ponseti serial casting protocol for clubfoot. Journal of pediatric orthopedics. 2012;32(4):412-5.
18.Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004;113(2):376-80.
19.Shaheen S, Jaiballa H, Pirani S. Interobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopaedic surgeon and a physiotherapy assistant. Journal of pediatric orthopedics Part B. 2012;21(4):366-8. Epub 2012/02/22.
20.Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. The Journal of bone and joint surgery American volume. 1995;77(10):1477-89.
21.Barker SL, Lavy CB. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. The Journal of bone and joint surgery British volume. 2006;88(3):377-9. Epub 2006/02/25.
22.Saini R, Dhillon MS, Tripathy SK, Goyal T, Sudesh P, Gill SS, et al. Regeneration of the Achilles tendon after percutaneous tenotomy in infants: a clinical and MRI study. Journal of pediatric orthopedics Part B. 2010;19(4):344-7.
2.Ponseti IV. Treatment of congenital club foot. The Journal of bone and joint surgery American volume. 1992;74(3):448-54. Epub 1992/03/01.
3.Brodhurst BE. On the nature and treatment of club-foot: and analogous distortions. London: J. Churchill; 1856. 134 p.
4.Ippolito E, Fraracci L, Farsetti P, Di Mario M, Caterini R. The influence of treatment on the pathology of club foot. CT study at maturity. The Journal of bone and joint surgery British volume. 2004;86(4):574-80. Epub 2004/06/04.
5.Feldbrin Z, Gilai AN, Ezra E, Khermosh O, Kramer U, Wientroub S. Muscle imbalance in the aetiology of idiopathic club foot. An electromyographic study. The Journal of bone and joint surgery British volume. 1995;77(4):596-601. Epub 1995/07/01.
6.Scher DM, Feldman DS, van Bosse HJ, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. Journal of pediatric orthopedics. 2004;24(4):349-52.
7.Lykissas MG, Crawford AH, Eismann EA, Tamai J. Ponseti method compared with soft-tissue release for the management of clubfoot: A meta-analysis study. World journal of orthopedics. 2013;4(3):144-53. Epub 2013/07/24.
8.Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. The Journal of bone and joint surgery American volume. 1980;62(1):23-31. Epub 1980/01/01.
9.Patwardhan PS, A. and Sancheti, P. Percutaneous Needle Tenotomy for Tendo-achillis Release in Clubfoot – Technical Note. J Orthopaedic case reports. 2012;2(1):35 -6.
10.Bor N, Coplan JA, Herzenberg JE. Ponseti treatment for idiopathic clubfoot: minimum 5-year followup. Clinical orthopaedics and related research. 2009;467(5):1263-70.
11.Mohan SM, Pawan, T., Mohan, S.S., Madhu, M.T. Modified Ponseti Technique for theManagement of Congenital Talipes Equino Varus (CTEV) in Neonates: Our Experience in a Rural Teaching Institution. Journal of Evolution of Medical and Dental Sciences. 2014;3(14):3618 - 26.
12.Hootnick DR, Packard DS, Jr., Levinsohn EM, Crider RJ, Jr. Confirmation of arterial deficiencies in a limb with necrosis following clubfoot surgery. Journal of pediatric orthopedics Part B. 1999;8(3):187-93. Epub 1999/07/10.
13.Bitariho D. Short-term outcome in one stage pantalar soft-tissue release with transfixation of talonavicular joint in resistant idiopathic congenital clubfoot. Unpublished: Makerere University); 2001.
14.Cowell HR, Wein BK. Genetic aspects of club foot. The Journal of bone and joint surgery American volume. 1980;62(8):1381-4.
15.Yamamoto H. A clinical, genetic and epidemiologic study of congenital club foot. Jinrui idengaku zasshi. 1979;24(1):37-44.
16.Dobbs MB, Morcuende JA, Gurnett CA, Ponseti IV. Treatment of idiopathic clubfoot: an historical review. The Iowa orthopaedic journal. 2000;20:59-64.
17.Lebel E, Karasik M, Bernstein-Weyel M, Mishukov Y, Peyser A. Achilles tenotomy as an office procedure: safety and efficacy as part of the Ponseti serial casting protocol for clubfoot. Journal of pediatric orthopedics. 2012;32(4):412-5.
18.Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004;113(2):376-80.
19.Shaheen S, Jaiballa H, Pirani S. Interobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopaedic surgeon and a physiotherapy assistant. Journal of pediatric orthopedics Part B. 2012;21(4):366-8. Epub 2012/02/22.
20.Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. The Journal of bone and joint surgery American volume. 1995;77(10):1477-89.
21.Barker SL, Lavy CB. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. The Journal of bone and joint surgery British volume. 2006;88(3):377-9. Epub 2006/02/25.
22.Saini R, Dhillon MS, Tripathy SK, Goyal T, Sudesh P, Gill SS, et al. Regeneration of the Achilles tendon after percutaneous tenotomy in infants: a clinical and MRI study. Journal of pediatric orthopedics Part B. 2010;19(4):344-7.
Published
2015-12-31
How to Cite
SHAHEEN, Samir; ABDALLA, Musaab Mohamed.
Safety and Efficacy of Achilles Tenotomy under Local Anaesthesia: as Part of the Ponseti Clubfoot Management -Experience at the Sudan clubfoot clinic.
Gezira Journal of Health Sciences, [S.l.], v. 11, n. 2, dec. 2015.
ISSN 1810-5386. Available at: <http://37.60.236.48/index.php/gjhs/article/view/1036>. Date accessed: 03 june 2026.
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