Percutaneous Achilles Tenotomy with a Large Gauge Needle in Ponseti Management of CTEV: A Modified Technique

Abstract

Introduction: Tenotomy of tendo achilles for clubfoot deformity is routinely done percutaneously with a surgical blade. This method though safe and effective, carries risk of complications such as excessive bleeding and injury to nearby neurovascular structures. Alternatively, sectioning of achilles tendon can be done safely by a large gauge needle percutaneously. Aim: To study the safety and effectiveness of the modified technique. Materials and Methods: A total of 37 children with 51 congenital clubfoot were included in this observational study. After successful correction of forefoot adduction and heel varus using the Ponseti technique, tendo achilles was sectioned percutaneously with a 16/18 gauge needle. Any complication occurring during the procedure was noted. Completeness of the tenotomy was checked by Thompson’s test and gain in passive dorsiflexion at ankle. Results: Complete division of tendon was achieved in all 51 feet. No incidence of excessive bleeding, neurovascular injury or formation of pseudoaneurysm was found. However, minor bleeding from the surgical site was noticed in three cases and was managed by applying mild pressure over the involved area. Conclusion: Percutaneous tenotomy of tendo achilles with a wide gauge needle is simple, safe and effective technique. It causes less morbidity and carries lesser risk of complications when compared to a surgical blade.

Keywords

• clubfoot
• equinus
• tendo achilles