Study of factors predicting the need for tenotomy in correction of clubfeet by ponseti method

Abstract

Background: Tendoachillis tenotomy is an integral step of ponseti method of treatment of clubfoot. Not all cases require tenotomy. It is important to study the factors predicting the need for tenotomy to aid in the selection of clubfeet requiring tenotomy and to determine the outcome of such cases in relation to those not requiring tenotomy. Aims and Objectives: The purpose of this study was to determine the factors which help in predicting the need for tenotomy in the Ponseti method of treatment of clubfoot. Materials and Methods: 35 cases with 55 clubfeet were assessed at presentation based on scoring system by Pirani et al. They were treated with Ponseti method. Tenotomy was performed in 37 of the 55 clubfeet (67%). Result: Need for tenotomy was significantly increased in clubfeet which were more severe at presentation (86.4% of cases with a Pirani score >=5) and more rigid (89.5% of clubfeet requiring >=7 casts). Hind foot contracture also correlated with increased need for tenotomy (81.25% clubfeet with hind foot score >2). Pirani scoring done following removal of last cast showed a score between 0 to 1, with a median score of 0.5 in both instances where tenotomy was required or not required. Conclusion: Clubfoot can be successfully treated with Ponseti technique by serial casting. Tenotomy is not required in all cases. Severity of the deformity at presentation, especially the hindfoot contracture along with the rigidity of the clubfoot can predict the need for tenotomy. Both cases requiring tenotomy and those not requiring, were well corrected at the end of casting. The need for tenotomy does not indicate poorer outcome.