Treatment Of Clubfoot Research Articles

Effects of educational material among children with clubfoot during bracing stage of treatment by Ponseti method

Aims: To identify effects of educational material among children with clubfoot during bracing stage of treatment by Ponseti method. Methods: This study was a quantitative type quasi-experimental research design. Actually, it was an experiment among specific groups and usual groups. Exercises applied with educational material to the material group or experiment group and only usual exercises applied to the non-material group or the control group. A pre-test (before exercises provided by educational material) and post-test (after exercises provided by educational material) was administered with each subject of both groups to compare the effects on children with clubfoot during bracing stage of treatment by Ponseti method. Results: The mean Pirani score before providing exercises with educational material for right feet among the clubfoot babies were 0.56 ± 0.33 (material group) and after providing exercises with educational material for right feet among the clubfoot babies were 0.43 ± 0.41 (material group). Statistically it was found highly significant (t = 2.99, p greater 0.0003). So, it was concluded that exercises with educational material had significant influence on Pirani score reduction for right feet among the clubfoot babies. The mean Pirani score before providing usual exercises for left feet among the clubfoot babies were 0.5 ± 0.15 (non-material group) and after providing usual exercises for left feet among the clubfoot babies were 0.53 ± 0.48 (non-material group). Statistically it was found significant (t = –0.059, p greater 0.056). So, it was concluded that usual exercises without educational material had influence on Pirani score increased for left feet among the clubfoot babies. Conclusion: The modern treatment of clubfoot is Ponseti method which is very effective, outcome oriented, and less invasive surgical procedure. This study was concluded that exercises with educational material had significant influence on Pirani score reduction among the children with club foot. So, there was significant importance of exercises with educational material rather than usual exercises by verbal instructions.

Usefulness and accessibility of information on the treatment of children with congenital clubfoot: results of a survey of parents

BACKGROUND: Treatment of congenital clubfoot remains controversial from both specialists and parents regarding the details of its practical application, individual effectiveness, and follow-up, rehabilitation treatment, prevention, and treatment of relapses. The assessment of parental attitudes using an online survey optimizes doctor–patient interaction. Information available to parents regarding the diagnosis and treatment of children with congenital clubfoot is lacking. AIM: This study aimed to assess the usefulness and accessibility of information for parents about the treatment of children with congenital clubfoot. MATERIALS AND METHODS: To assess the usefulness and accessibility of information about the treatment of congenital clubfoot, a survey of the patients’ parents was conducted using an electronic fillable form proposed for anonymous completion in a thematic group dedicated to the treatment of congenital clubfoot on the social network “VKontakte”; the study included 5500 participants at the time of the survey (2 weeks), with 328 responses received. RESULTS: Most parents noted a lack of information regarding clubfoot treatment before it actually began. The preferred source of information was Internet resources (i.e., websites of medical institutions and social networks). Achilles tenotomy and wearing braces raised the most questions, requiring additional information from both doctors and alternative sources. The possibility of errors and complications in wearing braces caused the greatest concern among parents, as well as possible relapses and the correctness of prescriptions during the rehabilitation treatment. Online parent communities and physician blogs are considered significant information sources. Most parents prefer to expand information about congenital clubfoot on the Internet, including social networks and popular resources. CONCLUSIONS: Analysis of the results of an anonymous survey of parents of children with congenital clubfoot showed a significant demand for high-quality, accessible information regarding the diagnosis, treatment, and rehabilitation of children with congenital clubfoot. Significant interest in the information provided by social media and other Internet resources determines the need for competent representatives of the professional community to participate in this process.

Outcomes of Ponseti Method for the Treatment of Clubfeet in Children With Spina Bifida.

While the Ponseti method is the primary treatment for idiopathic clubfoot, its application in treating myelodysplastic clubfeet is less certain. Myelodysplastic clubfoot tends to be more severe and difficult to treat. Although the Ponseti method can initially correct these cases, there is conflicting evidence about recurrence rates and the need for additional treatment. This study aims to assess the effectiveness of the Ponseti method in treating myelodysplastic clubfeet compared with idiopathic clubfeet over a 20-year period. The study conducted a retrospective review of medical records from patients treated for clubfoot at a single institution (2002 to 2021), comparing children with myelodysplastic and idiopathic clubfoot. Included patients were under 18, initially treated with Ponseti-casting, and had a minimum 2-year follow-up. Data on demographics, treatment details, recurrence, and Patient-reported Outcomes Measurement Information System (PROMIS) scores were analyzed. Forty-nine myelodysplastic and 512 idiopathic clubfeet in 366 patients met the inclusion criteria. Myelodysplastic cases had a median age of 5 months at presentation versus 2 months for idiopathic cases ( P =0.002). Initial correction was achieved in 95% of idiopathic and 87.8% of myelodysplastic feet ( P =0.185). Recurrence rates were higher in the myelodysplastic cohort, 65.3% versus 44.1% ( P =0.005). Surgery was necessary to treat recurrence in 59.2% of myelodysplastic and 37.7% of idiopathic cases, P =0.003. Follow-up was 3.9±1.8 years for myelodysplastic and 3.3±1.5 years for idiopathic feet, P =0.030. Myelodysplastic feet had lower PROMIS mobility scores; 31.94±7.56 versus 49.21±8.64, P <0.001. To the best of our knowledge, we report the largest series of myelodysplastic clubfeet treated by Ponseti casting and the first to assess PROMIS data. Overall, the Ponseti method is as effective in obtaining initial correction in myelodysplastic clubfoot as it is in idiopathic clubfoot. However, myelodysplastic clubfeet has a higher risk of relapse and increased need for surgical interventions. Children with spina bifida may need closer follow-ups and more stringent adherence to bracing. Level III-therapeutic studies-investigating the results of treatment.

Barriers to the treatment of clubfoot in low- and middle-income countries: A guide to improve compliance

The Ponseti method of clubfoot treatment is ideal for low- and middle-income countries since it is minimally invasive and easily implementable through non-surgeon providers. However, variables related to the socioeconomic status of the community, patient-related factors, treatment provider-related factors, and health system-related factors may influence the outcome of this deformity. These barriers need a two-pronged approach, a top-down (involvement at the policy level) as well as a bottom-up method (involvement at an individual level). Improving the knowledge level of the caregiver as well as the provider and addressing the issues regarding financial constraints will help in eliminating various barriers to the treatment of clubfoot. Furthermore, regular audits help in identifying the efficacy of various solutions employed as well as identifying new barriers to treatment. Integration at the policy level with the involvement of governmental as well as non-governmental organisations helps to remove health system-level bottlenecks.

Psychosocial Impacts of Idiopathic Clubfoot on Parents and Children: A Scoping Review Protocol.

Idiopathic clubfoot is a complex pediatric foot deformity. The Ponseti technique is widely regarded as the standard for correcting deformities, and treatment compliance is essential for preventing relapse. Examining psychosocial effects on parents and/or children during clubfoot treatment provides valuable insights for improving compliance. This scoping review will map the existing literature on the psychological and social effects experienced by parents and/or children with idiopathic clubfoot. It also aims to examine the assessment tools used to measure these impacts and identify factors influencing treatment compliance. This review will adhere to the Joanna Briggs Institute (JBI) guidelines for scoping reviews. The search will include databases such as Scopus, Web of Science, EBSCOhost, MEDLINE, and PsycINFO and focus on studies published in the last 10 years. This review will include quantitative, qualitative, and mixed-method studies that investigate the psychological and social effects experienced by parents or affected children of any age with idiopathic clubfoot. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension guidelines. The screening and data extraction process will involve two independent reviewers. The analysis will be descriptive and qualitative. The findings will be presented in tables and a narrative summary. This review may guide health practitioners in developing evidence-based interventions to improve treatment adherence.

Comparative Study of the Surgical Treatment of Congenital Club Foot between McKay and Turco Procedure

Background: Congenital clubfoot is one of the common congenital disorders. Surgery plays an important role in the treatment of patients with this deformity. Comparative studies after surgical treatment might be beneficial. Hypothesis: Surgical treatment of congenital idiopathic club foot by McKay procedure gives better results than Turco procedure. Objectives: To compare the outcome of surgical treatment of congenital idiopathic club foot between McKay procedure and Turco procedure. Methods: This is a prospective interventional study carried out at Orthopaedic Department of Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, during the period of January 2007 to December 2008. 25 patients with 36 feet were selected in which Group-I consisted of 13 patients with 19 feet treated with surgery by Mckay's procedure and Group- II consisted of 12 patients with 17 feet treated with surgery by Turco's procedure. All the ethical considerations were fulfilled. A questionnaire was designed and prepared by the researcher himself. Diagnosis was confirmed by detailed medical history, clinical examinations and relevant investigations. Then through Turco or cincinnati incision surgery was done in two groups. Statistical analysis were done by SPSS (Statistical Package for the Social Science). Results: There were satisfactory results (Excellent + Good) in 17 feet (89.47%) and unsatisfactory results (fair + poor) were in 2 feet (10.53%) in Mckay's procedure. Where as satisfactory results (Excellent + Good) were in 9 feet (52.94%) and unsatisfactory results (fair + poor) were in 8 feet (47.06%) in Turco's procedure. Conclusion: Operative treatment of congenital clubfoot deformity is always an accepted method of treatment. The final outcome of the results shows that in Mckay's procedure satisfactory results was found in 89.47% which is more than Turco's procedure 52.94%.

Surgical Techniques of Gastrocnemius Recession and Achilles Tendon Lengthening (Descriptive Review Article)

This paper aims to review the various surgical techniques for gastrocnemius–soleus recession and Achilles tendon lengthening, with a special focus on the treatment of clubfoot and cerebral palsy (CP) equinus contracture. This descriptive review article comprehensively explores different techniques for gastrocnemius recession, including the Hoke percutaneous triple hemisection, Baker’s method (Tongue-in-Groove Gastrocnemius–Soleus Recession), the Vulpius method, the Baumann procedure, and the Strayer procedure (Gastrocnemius Recession). The objective is to present a detailed analysis of these methods, covering their indications, procedural nuances, relevance in clinical practice, and outcomes.

Percutaneous Achilles tendon tenotomy in clubfoot with a blade or a needle: a single-centre randomized controlled noninferiority trial.

The gold standard for percutaneous Achilles tendon tenotomy during the Ponseti treatment for idiopathic clubfoot is a tenotomy with a No. 15 blade. This trial aims to establish the technique where the tenotomy is performed with a large-bore needle as noninferior to the gold standard. We randomized feet from children aged below 36 months with idiopathic clubfoot on a 1:1 basis in either the blade or needle group. Follow-up was conducted at three weeks and three months postoperatively, where dorsiflexion range, Pirani scores, and complications were recorded. The noninferiority margin was set at 4° difference in dorsiflexion range at three months postoperatively. The blade group had more dorsiflexion at both follow-up consultations: 18.36° versus 18.03° (p = 0.115) at three weeks and 18.96° versus 18.26° (p = 0.001) at three months. The difference of the mean at three months 0.7° is well below the noninferiority margin of 4°. There was no significant difference in Pirani scores. The blade group had more extensive scar marks at three months than the needle group (8 vs 2). No major complications were recorded. The needle tenotomy is noninferior to the blade tenotomy for usage in Ponseti treatment for idiopathic clubfoot in children aged below 36 months.

The perspectives of caregivers and health service providers on barriers to clubfoot management in Puri-Urban health facility in Ghana.

Clubfoot is a common disabling condition that is prevalent across all populations. Approximately, one out of 750 children globally suffers from clubfoot, and around 150,000 to 200,000 children are born with clubfoot every year with 80% of the cases occurring in developing countries. Clubfoot can result in mobility impairments when not properly managed and researchers have argued that understanding knowledge and perceptions are key components to early identification and effective management of clubfoot. The study explored the barriers to clubfoot management from the perspectives of caregivers and healthcare providers in Duayaw Nkwanta, Ghana. A total of 26 participants made up of 22 caregivers of children with clubfoot and six healthcare providers were purposively sampled for the study guided by a set of inclusion and exclusion criteria. Qualitative data were collected using a semi-structured interview guide through in-depth face-to-face interviews. Interviews were transcribed and analyzed thematically and presented as findings. High cost of treatment, long travel distance, long hours spent at the treatment facility, non-availability of clubfoot treatment services, late reporting of clients for treatment, and non-compliance of parents/caregivers with treatment protocols were identified as the barriers to effective management of clubfoot. These findings have substantial implications for current interventions to effectively manage clubfoot in Ghana.

Pitfalls and complications in the treatment of clubfoot by the Ponseti method: A literature review

BACKGROUND: At every step of clubfoot treatment using the Ponseti method, pitfalls leading to complications, both minor and potentially dangerous, may occur. Any doctor involved in the treatment of clubfoot may encounter similar difficulties in their practice; however, publications devoted to this problem are limited, and in some cases, experts cannot reach a consensus regarding the interpretation of actions that entail undesirable consequences. AIM: This study aimed to analyze pitfalls and complications associated with the Ponseti method for the treatment of clubfoot using modern literature data. MATERIALS AND METHODS: Articles were searched for in PubMed, Science Direct, Google Scholar, and eLibrary databases using the following keywords: idiopathic clubfoot, Ponseti method, serial casting, bracing, Achilles tenotomy, pitfalls, and complications. The search was performed without language restrictions. Most of the studies included were published no more than 10 years ago. RESULTS: Current literature data present on the pitfalls and complications encountered in the treatment of clubfoot using the Ponseti method. The review also covered associated complications and unfavorable prognostic factors. The restrictive measures during the COVID-19 pandemic have affected the treatment of clubfoot. CONCLUSIONS: Analysis of the causes of pitfalls and complications and control of unfavorable prognostic factors will help reduce complications of clubfoot treatment using the Ponseti method and optimize orthopedic care for children.

Innovative Recycled PET 3-D Printed Foot Abduction Orthosis for Infant Clubfoot Treatment

This paper presents the development of an innovative and cost-effective 3-D printed Foot Abduction Orthosis (FAO) for the treatment of infant clubfoot, specifically addressing the challenges faced in resource-constrained regions such as Ethiopia. The Ponseti technique of treating clubfoot, also known as congenital talipes equinovarus, necessitates the use of FAOs, which are often prohibitively expensive in low-resource settings.

Delayed Achilles Tendon Rupture at 17 Years of Age After Treatment of Clubfoot with Ponseti Method: A Case Report.

Traumatic pediatric Achilles ruptures are rare, and few cases have been reported among patients with a history of Achilles tenotomy. A 17-year-old boy with a history of Achilles tenotomies for congenital clubfoot as an infant presented with acute midsubstance Achilles tendon rupture of the right leg. The gastrocnemius fascia was dissected to allow for approximation of the ruptured Achilles tendon segments. Furthermore, the plantaris tendon was harvested and sutured around the Achilles tendon-rupture site to improve strength. Patients with a history of clubfoot and chronic Achilles tendon pain should be alerted to the risk of Achilles tendon rupture.

The Core outcome Clubfoot (CoCo) study: relapse, with poorer clinical and quality of life outcomes, affects 37% of idiopathic clubfoot patients.

There is a lack of high-quality research investigating outcomes of Ponseti-treated idiopathic clubfeet and correlation with relapse. This study assessed clinical and quality of life (QoL) outcomes using a standardized core outcome set (COS), comparing children with and without relapse. A total of 11 international centres participated in this institutional review board-approved observational study. Data including demographics, information regarding presentation, treatment, and details of subsequent relapse and management were collected between 1 June 2022 and 30 June 2023 from consecutive clinic patients who had a minimum five-year follow-up. The clubfoot COS incorporating 31 parameters was used. A regression model assessed relationships between baseline variables and outcomes (clinical/QoL). Overall, 293 patients (432 feet) with a median age of 89 months (interquartile range 72 to 113) were included. The relapse rate was 37%, with repeated relapse in 14%. Treatment considered a standard part of the Ponseti journey (recasting, repeat tenotomy, and tibialis anterior tendon transfer) was performed in 35% of cases, with soft-tissue release and osteotomies in 5% and 2% of cases, respectively. Predictors of relapse included duration of follow-up, higher initial Pirani score, and poor Evertor muscle activity. Relapse was associated with poorer outcomes. This is the first multicentre study using a standardized COS following clubfoot treatment. It distinguishes patients with and without relapse in terms of clinical outcomes and QoL, with poorer outcomes in the relapse group. This tool allows comparison of treatment methods and outcomes, facilitates information sharing, and sets family expectations. Predictors of relapse encourage us to create appropriate treatment pathways to reduce relapse and improve outcome.

About a person with a missing limb and a clubfoot in one of their legs (congenital talipes equinovarus, or CTEV)

The Ponseti technique has a higher success rate than any other method now used in physiotherapy practice for the treatment of congenital talipes equinovarus or clubfoot. The study’s objective was to discover proof that using the Ponseti approach for clubfoot challenging functional results and missing limb by prosthetic shoes. A baby girl who was 1 month and 6 days old and had no prior history of complications for either her mother or herself visited Centre for the Rehabilitation of the Paralysed (CRP). We identified her as having unilateral normal clubfeet (left) and missing limb in right, and throughout the casting process, her midfoot scored higher than her hindfoot. On the first casting day, feet had a total Pirani score (PS) of 5.5. Total casting was necessary, and the right feet’s PSs were 1.5 and 1, respectively. Just before the casting, she had manipulation (exercise therapy). After nine casting, Pirani’s score was zero. Afterward, the patient was given the brace and prosthetic in the 4 size. This study’s findings suggest that using the Ponseti approach yields comprehensive clinical and functional results and missing limb by prosthetic shoes.

Initial clubfoot treatment in Sweden from 2016 to 2019: A national register study.

This study aimed to describe the initial treatment of clubfoot deformity in Sweden using a national cohort. Secondarily we aimed to analyse the results of the initial treatment in relation to foot severity and additional diseases. A national register, the Swedish Pediatric Orthopedic Quality Register, was used to extract data on children born with clubfoot in 2016-2019. Children with a registered evaluation after initial treatment were included. Data on deformity severity (Pirani score), casting treatment, and achillotenotomy were extracted. For children with bilateral clubfeet, one foot was included in the analysis. A total of 565 children were included in the analysis. Of these, 73% were boys and 47% had bilateral clubfeet. Children with isolated clubfoot required a median of six casts to correct the deformity, while children with non-isolated clubfoot needed a median of eight casts. Seventy-seven percent underwent an achillotenotomy. Residual deformities of 0.5 or above (often soft-tissue issues) according to the Pirani score were noted in 23% (isolated clubfoot) and 61% (non-isolated clubfoot) after initial treatment. We have described the initial clubfoot treatment of children born with isolated or non-isolated clubfoot in Sweden based on data from a national register. The initial treatment was performed to a large extent according to the Ponseti method and international recommendations. Moreover, we discuss the usefulness of the Pirani score in classifying clubfoot deformity after treatment.

The Efficacy of General Anesthesia with Sevoflurane for Pain Management in Neonates and Infants with Idiopathic Clubfoot Treated with Ponseti Technique and Percutaneous Achilles Tenotomy

Background: Idiopathic clubfoot deformity is a relatively common congenital pediatric foot deformity. A percutaneous Achilles tenotomy (PAT) is required to correct the equinus deformity as it is the most resistant component of clubfoot deformity. Although this procedure is mainly performed with local anesthesia, performing this procedure with general anesthesia has significant advantages. Aims: The purpose of this study was to compare the safety and efficacy of post-procedural pain management of PAT in the treatment of clubfoot with the Ponseti method when performed in a clinic setting with local anesthetic or under general anesthesia Methods: This is a multicentric prospective observational evaluation on children less than one year of age with idiopathic clubfoot whom referred for Ponseti casting and PAT. This procedure was done in the control group with local anesthesia and in the intervention group with Sevoflurane mask 8% (MAC 2) and maintenance of anesthesia with Sevoflurane mask 4% (N2O/O2, 50%). The neonatal infant pain scale (NIPS), the amount of milk, and mood changes were evaluated as a criterion to measure the pain level. Results: NIPS score in the intervention group was significantly lower than the control group. Children in the intervention group consume significantly more milk than the control group. Furthermore, 76% of children in the intervention group were classified as "calm," 24% as "relatively restless," and no child was classified as "severely restless." While in the control group, 54% of children were classified as "severely restless," and the remaining 46% as "relatively restless." Conclusion: Our result showed that using general anesthesia to perform achillotomy in the treatment of clubfoot in children could be associated with less pain in these patients and without significant complications.

Assessing the Influence of Age, Weight, and Pirani Score on the Number of Casts During the Initial Phase of Clubfoot Treatment Using the Ponseti Method: A Prospective Study.

Clubfoot, also known as congenital talipes equinovarus is a prevalent childhood ailment that, if untreated, can lead to long-term discomfort and impairment. The Ponseti technique, aimed at achieving corrected foot positioning, is widely accepted. This study investigated the influence of clubfoot severity (Pirani score), patient age, and initial manipulation and casting weight on the overall number of casts needed for effective treatment. A prospective study was carried out involving 40 idiopathic clubfoot patients where manipulation and casting were performed following the Ponseti method. Patient age, weight, and foot Pirani score were evaluated concerning the total number of casts needed to achieve 70° of abduction. The majority of participants were male infants aged 4-6months, with a median age of 4.5months. Half of them weighed between 3.00 and 4.99kg at their first hospital visit, with a median weight of 3.20kg. Bilateral clubfoot involvement was common (57.5%). Children with Pirani HFCS 2.0-3 often required percutaneous tenotomy (87.5%, p value 0.05). On average, patients needed 5 casts (range 3-9). The mean total Pirani scores were 4.71 for the right foot and 4.61 for the left foot. The study reported a positive correlation between higher total Pirani scores and the required number of casts. The Pirani scoring system is highly accurate in assessing clubfoot severity and predicting treatment success. It emerged as the single most significant predictor for both the total number of casts and the need for percutaneous tenotomy.

Barriers to Accessing Clubfoot Treatment in South Africa

This journal review critically examines the barriers to accessing clubfoot treatment within the context of South Africa. Through a comprehensive search on PubMed, four pertinent studies were identified and thoroughly analyzed based on predefined inclusion and exclusion criteria. The findings highlight significant impediments hindering access to clubfoot treatment, with prominent factors including geographical distance to treatment facilities, limited awareness regarding the severity of the condition, and logistical challenges in accessing specialized care. While these identified barriers shed light on the current challenges faced by clubfoot patients in South Africa, the review underscores the necessity for further research to comprehensively explore additional barriers and their underlying causes across diverse regions within the country. This extended analysis emphasizes the multifaceted nature of obstacles to accessing clubfoot treatment and underscores the imperative for targeted interventions to enhance accessibility and mitigate disparities in care delivery.

Missed Visits Predict Recurrence in Idiopathic Clubfoot.

Congenital talipes equinovarus, also known as "clubfoot," is a common congenital deformity. While reported relapse rates vary widely, relapse continues to be a common problem faced in the treatment of this condition. The objective of this study is to assess relationships between demographic/socioeconomic factors, follow-up, and rates of relapse in our population of clubfoot patients. Retrospective chart review was conducted for patients undergoing treatment for idiopathic clubfoot from February 2012 to December 2022 at a tertiary children's hospital. Records were analyzed for follow-up adherence and recurrence in the Ponseti method, in addition to patient demographic and socioeconomic factors. Statistical analysis was performed to evaluate associations between recurrence, missed clinical visits, and demographic/socioeconomic factors of interest. Ninety-five patients were included in the study [74.7% male (N=71) and 25.2% female (N=24)]. A total of 64.2% (N=61) of patients developed recurrence during their treatment. Recurrence rates differed significantly by reported bracing noncompliance >1 month (35/46 vs. 26/49, P =0.019), having missed 1 or more clinical visits (38/61 vs. 8/34, P < 0.001), Medicaid or equivalent insurance type (41/56 vs. 20/39, P =0.028), non-white race (47/66 vs. 14/29, P =0.032, higher Social Deprivation Index score (56.13 vs. 41.06, P =0.019). Significant variables were analyzed using a multivariate logistic regression analysis (MVLR). After MVLR, having 1 or more missed clinical visits (OR 4.462, 95% CI: 1.549-12.856) remained significantly associated with increased rates of recurrence. Primary language preference and distance to the hospital were not associated with recurrence. Higher SDI scores, non-white race, Medicaid insurance, and missed clinical follow-up visits were all associated with increased rates of recurrence for clubfoot patients. Using an MVLR model, missed clinical follow-up visits remained independently associated with increased recurrence rates. Level 2-retrospective, prognostic study.

Reliability of Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot.

Talipesequinovarus is a congenital ankle/foot malformation that commonly affects newborns. In its treatment using the Ponseti method, an Achilles tenotomy is frequently needed to correct residual equinus deformity. Percutaneous (PC) tenotomy is the most commonly used technique and needs to be thoroughly evaluated. The question we needed to answer was: "Does PC Achilles tenotomy result in complete tendon sectioning"? This clinical study included 56 idiopathic clubfeet in 36 patients who presented during the first 6 months of life and were treated with Ponseti manipulation and casting followed by PC Achilles tenotomy. PC tenotomy was done under general anesthesia, and Thompson's calf squeeze test was performed intraoperatively just after tenotomy. In case of a negative test (ie, ankle plantar flexion with calf squeeze), the percutaneous incision was extended to assess the cause of the negative test. Forty-nine feet (87.5%) had a complete tenotomy, as evidenced by a positive Thompson's calf squeeze test. While 7 feet (12.5%) showed a negative test, and therefore the percutaneous incision was extended and all were found to have an incompletely divided Achilles tendon. The tendons were then completely divided, after which Thompson's test became positive in all. Percutaneous Achilles tenotomy is a reliable procedure, but was found to result in incomplete tendon sectioning in 12.5% of cases, affecting the range of ankle dorsiflexion. Thompson's squeeze test is reliable in picking up cases of incomplete tenotomy after the PC technique, and in these cases the incision should be extended for complete sectioning. Level I.