Clubfoot or Congenital talipes equinovarus (CTEV) is one of the most commonl congenital pediatric foot deformity with an incidence of 1 in 1000 live births [1, 2]. equinus at ankle, hindfoot varus, forefoot adduction, and midfoot cavus are the four components [3–6]. Historically, Hippocrates,introduced conservative management in around 400 BC [10, 11]. Later, Kite introduced a method [12] in 1993, which included manipulation and casting technique, but the success rate was poor [7, 8, 13]. Subsequently, Ponseti in 1963 developed a conservative method, called as Ponseti technique, consisting of serial manipulation, casting, tendoachilles tenotomy and casting and it takes about four to five weeks to achieve the full correction of all four
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The technique involves serial manipulation and casting and possible percutaneous tendoachilles tenotomy. About 85% of the cases treated with this technique require percutaneous tendo-achilles tenotomy for correction of residual equinus deformity.16-19 Percutaneous tenotomy by surgical knife is widely ues all over across the world but recently new technique by using wide bore surgical neddle is increasingly used in the last decade which was first described by Minkowitz et al.[20,21,22]. 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[ 23], formation of a pseudoaneurysm[24] and neurovascular injuries[25], were described. To avoid these rare but serious complications, many modifications such as mini-open tenotomy and needle tenotomy The technique with needle may possibly have advantages when compared to others tendon lengthening techniques, duo to the minimally invasive approach, the simplicity and very low morbidity.23,24 Percutaneous tenotomy with a needle is performed in an outpatient setting and under local anesthesia. The surgeon avoids incising the …show more content…
All the children with CTEV presenting to orthopaedics opd in Kr hospital during this period were treated by the Ponseti casting technique. Only the idiopathic CTEV cases were included in the study. Ctev Children with assosiated other congenital deformities, syndromes or neurological causes of club feet and children with incomplete follow up were excluded from the study. 25 children with20 bilateral and 5 unilateral affected foot met with inclusion and exclusion criteria were included in the study and managed by ponseti technique i.e. weekly manipulation and casting of affected foot,PIRANI scoring system used to asses correction and tendoachilles tenotomy is planned when midfoot - pirani score is zero. In 2 children with bilateral affected foot and 2 child with unilateral foot affected, acceptable dorsiflexion acheived by casting and not considered for tenotomy. Hence a total of 39 affected have undergone tenotomy for tendo Achilles using a 16G
The technique involves serial manipulation and casting and possible percutaneous tendoachilles tenotomy. About 85% of the cases treated with this technique require percutaneous tendo-achilles tenotomy for correction of residual equinus deformity.16-19 Percutaneous tenotomy by surgical knife is widely ues all over across the world but recently new technique by using wide bore surgical neddle is increasingly used in the last decade which was first described by Minkowitz et al.[20,21,22]. 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[ 23], formation of a pseudoaneurysm[24] and neurovascular injuries[25], were described. To avoid these rare but serious complications, many modifications such as mini-open tenotomy and needle tenotomy The technique with needle may possibly have advantages when compared to others tendon lengthening techniques, duo to the minimally invasive approach, the simplicity and very low morbidity.23,24 Percutaneous tenotomy with a needle is performed in an outpatient setting and under local anesthesia. The surgeon avoids incising the …show more content…
All the children with CTEV presenting to orthopaedics opd in Kr hospital during this period were treated by the Ponseti casting technique. Only the idiopathic CTEV cases were included in the study. Ctev Children with assosiated other congenital deformities, syndromes or neurological causes of club feet and children with incomplete follow up were excluded from the study. 25 children with20 bilateral and 5 unilateral affected foot met with inclusion and exclusion criteria were included in the study and managed by ponseti technique i.e. weekly manipulation and casting of affected foot,PIRANI scoring system used to asses correction and tendoachilles tenotomy is planned when midfoot - pirani score is zero. In 2 children with bilateral affected foot and 2 child with unilateral foot affected, acceptable dorsiflexion acheived by casting and not considered for tenotomy. Hence a total of 39 affected have undergone tenotomy for tendo Achilles using a 16G