Outcome of Percutaneous Tenotomy in the Management of Congenital Talipes Equino Varus by Ponseti Method.

Congenital talipes equino varus (CTEV) is a common complex congenital anomaly affecting approximately 1 per 900 live births in Bangladesh. Current trends in the treatment of idiopathic clubfoot have shifted from extensive surgical release to more conservative techniques. The Ponseti method that includes manipulation, serial casting, percutaneous tenotomy and bracing has recently become very popular for the management of CTEV with reported excellent outcomes. The purpose of this study was to evaluate the outcomes of Percutaneous Tenotomy in the treatment of equinus deformity of idiopathic clubfoot. Between June 2012 and November 2013 we treated 47 feet in 34 children by the Ponseti method. The standard protocol described by Ponseti was used. Percutaneous tenotomy of the Achilles tendon was performed under local anaesthesia in the outpatient department of Dhaka Medical College Hospital. The Pirani score was used for assessment and mean follow up time was 12 months. The compliance of percutaneous tenotomy among the 47 feet was recorded and 40(85.1%) were good, 4(8.5%) were fair and 3(6.4%) were poor. The rating of final outcome of percutaneous tenotomy after one year follow-up periods among 47 feet, 36(76.6%) were good, 11(23.4%) were fair and zero (0%) were poor. This study permits to conclude the percutaneous tenotomy in Ponseti method as a safe, effective outdoor procedure to correct the residual equinus deformity of club foot after serial casting.