A study of outcome of percutaneous needle tenotomy for tendoachilles release in congenital talipes equino varus

Introduction: Congenital TalipesEquino Varus (CTEV) is a commonly seen complex congenital deformity of the foot, with an incidence of approximately 1 in 1000 live births. Over the past two decades, Ponseti management has become accepted throughout the world as the most effective and least expensive treatment of clubfoot. About 85% of the cases treated with the Ponseti technique require percutaneous sectioning of the tendoachilles for correction of residual equinus deformity. The sectioning of the tendoachilles is simple, effective and involves low risks. Originally, as described by Ponseti, tenotomy is performed using a tenotomy blade, such as a #11 or #15, or any other small blade, such as an ophthalmic knife. However, complications related to the procedure, such as excessive bleeding, formation of a pseudoaneurysm and neurovascular injuries, were described. To avoid these rare but serious complications, many modifications such as mini-open tenotomy and needle tenotomy, have been developed. Materials and Methods: The study was performed in the Department of Orthopaedics, Govt Medical College Jammu from November 2015 to October 2016. All the children with CTEV presenting during this period were treated by the Ponseti casting technique. Only the cases with idiopathic CTEV were included in the present study. Results: Between November 2015 and October 2016, twenty five patients with idiopathic clubfoot presented to department. Out of them, fourteen (56%) were male and eleven (44%) were females, sixteen (64%) have unilateral and nine(36%) had bilateral club foot. Out of these twenty five, twenty one (84%) were managed successfully. In case of two (8%) patients percutaneous needle tenotomy failed. Due to poor and faulty application of D-B splint and irregular follow up, (8%) patients developed relapse of the deformity. There were no cases of blister formation, excessive bleeding, psuedoaneurysm formation or neurovascular compromise. Conclusion: In this study we performed the modified technique of tenotomy with a wide bore needle, as described by Minkowitz et al, as we consider this technique easy, simple, cost effective, and with fewer complication rates.