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No incidence of relapse found in infants with severe rigid clubfoot after multiple tenotomies
ElTayeby H. J Foot Ankle Surg. 2011. doi:10.1053/j.jfas.2011.10.038.
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Surgeons found no relapse in infants with severe rigid clubfoot by using the Ponseti method after performing multiple tenotomies, according to the study.
Researchers examined 30 severe rigid idiopathic clubfeet in infants between 2 days and 24 days old from November 2002 to December 2004. After performing the Ponseti method, researchers proposed a technique where surgeons could perform open, minimally invasive tenotomies at the Achilles tendon, flexor digitorum longus and tibialis posterior areas to improve function in clubfeet. They also performed a posterior capsulotomy of the ankle in all but four patients and were able to achieve dorsiflexion greater than 30°. Postoperatively, an above-the-knee plaster cast was applied at extreme dorsiflexion and 70° hyperabduction for 6 weeks to 8 weeks, followed by a hyperabduction brace for another 6 months.
Pirani scores dropped from initial presentation. Patients after posterior capsulotomy had a 10° to 20° dorsiflexion compared with the patients who did not undergo the procedure, who had a dorsiflexion of 5° to 10°. At mean 3.8-year follow-up, nearly all clubfeet patients had satisfactory outcomes, according to the abstract. A single patient who was unresponsive to manipulation and casting had the deformity corrected at age 2 years through tibialis anterior transfer and posteromedial release.