Can we treat idiopathic CTEV without tenotomy? A prospective study

Abstract

Tendoachillis tenotomy is the procedure of choice to correct equinus deformity in Ponseti technique. Though Tenotomy is the most frequently done procedure, is associated with complications in 11% to 50% of cases. So, we were in search of an alternative which would have less complication and will give similar results to a standard tenotomy. One such method is Botulinum toxin type A injection into the gastronemius-soleus muscle which causes reversible paralysis of the muscle leading to lengthening of muscle unit, easy manipulation and casting. In our study, we compared the outcomes of Botulinum toxin with tenotomy in the correction of hindfoot equinus in children (<2>0.05) between the two groups in the post-intervention Pirani score and ankle dorsiflexion was seen at 3&6 weeks and 3,6,12 month post intervention. Average dorsiflexion was around 11±1º in both groups upto 1 year post intervention.Early results shows that Botulinum toxin type A is a good alternative to a routine tendoachillis tenotomy to correct hindfoot equinus in the management of clubfoot by the Ponseti method.