Necessity of Tendoachilles Tenotomy in Patients With Congenital Talipes Equinovarus (CTEV) Treated Using the Ponseti Technique: A Prospective Cohort Study.

Aim: This study aims to determine how often Achilles tenotomy is performed on patients who have congenital talipes equinovarus (CTEV) and have been managed with Ponseti serial casts.

Materials And Methods: This prospective cohort study took place from November 2021 to May 2023 in the orthopedic unit of Hayatabad Medical Complex, Peshawar, Pakistan. About 38 pediatric patients with CTEV, who received treatment in the form of Ponseti casting, were enrolled in the study. Clinicodemographic data of the patients were recorded. Informed consents were taken prior to enrollment.

Results: Using the Ponseti casting method, 56 feet in 38 pediatric patients with CTEV, were treated. Of 38 patients, 27 (71.05%) were male and 11 (28.94%) were female. Fourteen (36.84%) out of 38 had a right foot, 6 (15.7%) had a left foot, and 18 (47.36%) had bilateral foot involvement. The mean age was 8.8±2.5 weeks (ranging from 5 to 13 weeks) when they were subjected to Achilles tenotomy. The initial mean Pirani score was 3±0.74 while the final Pirani score was 1±0.74 after Ponseti casting, showing the efficacy of Ponseti casting correcting the cavus, varus, and adduction components of clubfoot. The mean number of casts was 5±0.84 to correct the aforementioned components of clubfoot. In 34 feet (60.71%) the residual equines deformity was persistent and Achilles tenotomy was done to make the foot plantigrade. In the end, all 38 patients had plantigrade feet.

Conclusion: Equinus deformity was present in over 60% of the patients following Ponseti serial casting, highlighting the need for tendoachilles tenotomy to make the foot plantigrade. A combination of Ponseti casting and tendoachilles tenotomy resulted in plantigrade feet in 100% of patients.