Achilles tendon surgery in clubfoot: Are long term sequelae predictable?


Submitted: 28 November 2021
Accepted: 7 April 2022
Published: 3 May 2022
Abstract Views: 1422
PDF: 168
HTML: 39
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Luisella Pedrotti Clinical Surgical Department, Diagnostic and Pediatric Sciences, Locomotor System Diseases Unit, University of Pavia, Pavia; Orthopedic and Traumatology Unit, Città di Pavia Institute, Pavia, Italy.
  • Barbara Bertani Orthopedic and Traumatology Unit, Città di Pavia Institute, Pavia, Italy.
  • Gabriella Tuvo Orthopedic and Traumatology Unit, Città di Pavia Institute, Pavia, Italy.
  • Redento Mora Orthopedic and Traumatology Unit, Città di Pavia Institute, Pavia, Italy.
  • Luca Marin Laboratory of Adapted Motor Activity, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
  • Federica De Rosa Pediatric Orthopedic and Traumatology Unit, Children’s Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.

Congenital Clubfoot (CCF) treatment involves a surgical procedure on the Achilles tendon most of the time, i.e. tenotomy or, in selected cases, Z-plasty lengthening. Many authors have studied the outcomes of Achilles tenotomy, describing complete clinical and ultrasound tendon fibers integrity restoration 3-6 weeks after surgery. Nevertheless, little is known about the mechanical properties of the operated tendon. Recently, cases of subcutaneous rupture of the Achilles tendon have been described in adolescents who practiced sports and who had undergone Achilles tenotomy for congenital clubfoot in childhood. Authors report two cases of atraumatic Achilles tendon injury (subcutaneous rupture and intratendinous ossification) in adult patients who had been treated for congenital clubfoot in childhood. In both cases, no causes determining the injury were identified; in the medical history there was a Z-plasty lengthening of the Achilles tendon, performed within the first year of life, which could be considered a predisposing factor. The usefulness of long-term monitoring of patients treated for CCF with surgical procedures on the Achilles tendon is therefore hypothesized, in order to promptly identify by symptoms, clinical pictures and ultrasound criteria, tendon suffering that may predispose subcutaneous rupture.


Jowett CR, Morcuende JA, Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method. J Bone Joint Surg Br 2011;93:1160-4. DOI: https://doi.org/10.1302/0301-620X.93B9.26947

Gray K, Pacey V, Gibbons P, et al. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev 2014;2014:8. DOI: https://doi.org/10.1002/14651858.CD008602.pub3

Pavone V, Testa G, Costarella L, et al. Congenital idiopathic talipes equinovarus: An evaluation in infants treated by the Ponseti method European Review for Medical and Pharmacological Sciences 2013;17:2675-9

Ponseti IV, Smoley EN. The classic congenital club foot: The results of treatment. 1963. Clin Orthop Relat Res 2009;467:1133-45. DOI: https://doi.org/10.1007/s11999-009-0720-2

Radler C. The Ponseti method for the treatment of congenital club foot: Review of the current literature and treatment recommendations. Int Orthop 2013;37:1747-53. DOI: https://doi.org/10.1007/s00264-013-2031-1

Agarwal A, Qureshi NA, Kumar P, et al. Ultrasonographic evaluation of Achilles tendons in clubfeet before and after percutaneous tenotomy. J Orthop Surg 2012;20:71-4 DOI: https://doi.org/10.1177/230949901202000114

Watzl MTP, Santos AASMD, Ferreira Neto AL, Araujo DA. Ultrasonographic aspects of the Achilles tendon after tenotomy for the treatment of congenital clubfoot by the Ponseti technique. Radiol Bras 2020;53:34–5 DOI: https://doi.org/10.1590/0100-3984.2018.0086

Niki H, Nakajima H, Hirano T, et al. Ultrasonographic observation of the healing process in the gap after a Ponseti-type Achilles tenotomy for idiopathic congenital clubfoot at two-year follow-up. J Orthop Sci 2013;18:70–5 DOI: https://doi.org/10.1007/s00776-012-0312-y

Barker SL, Lavy CBD: Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. J Bone Joint Surg Br 2006;88-B:377-9 DOI: https://doi.org/10.1302/0301-620X.88B3.17273

Maranho DA, Nogueira-Barbosa MH, Simᾶo MN, Volpon JB. Ultrasonographic Evaluation of Achilles Tendon Repair After Percutaneous Sectioning for the Correction of Congenital Clubfoot Residual Equinus J Pediatr Orthop J Pediatr Orthop 2009;29:804-10. DOI: https://doi.org/10.1097/BPO.0b013e3181b76a5f

Maranho DA, Leonardo FH, Herrero CF, et al. The quality of Achilles tendon repair five to eight years after percutaneous tenotomy in the treatment of clubfoot: clinical and ultrasonographic findings. Bone Joint J 2017;99-B:139-44. DOI: https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0131.R1

Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am 1992;74:448–54 DOI: https://doi.org/10.2106/00004623-199274030-00021

Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 2002;22:517–21. DOI: https://doi.org/10.1097/01241398-200207000-00019

Bor N, Coplan JA, Herzenberg JE. Ponseti treatment for idiopathic clubfoot. Minimum 5-year followup. Clin Orthop Relat Res 2009;467:1263–70. DOI: https://doi.org/10.1007/s11999-008-0683-8

Egger AC, Levine AD, Mistovich RJ. Acute Rupture of Achilles Tendon in an Adolescent with a History of Ponseti Casting and Achilles Tenotomy: A Case Report. JBJS Case Connect 2019;9:e0197 DOI: https://doi.org/10.2106/JBJS.CC.18.00197

Aretakis AC, Georgopoulos G. Sequential Bilateral Achilles Tendon Rupture in a Teenager After Ponseti Treatment for Bilateral Clubfoot: A Case Report. JBJS Case Connect 2021;11. DOI: https://doi.org/10.2106/JBJS.CC.20.00929

Gigante C, Pedrotti L, Guido D. Proposal of an innovative casting technique for correction of clubfoot according to Ponseti method: A pilot study. J Pediatr Orthop B 2019;28:242-7. DOI: https://doi.org/10.1097/BPB.0000000000000539

Bhaskar A, Patni P. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop 2013;47:370-6. DOI: https://doi.org/10.4103/0019-5413.114921

Kadhum M, Lee MH, Czernuszka J, Lavy C. An analysis of the mechanical properties of the Ponseti method in clubfoot treatment. Appl Bionics Biomech 2019;2019:4308462. DOI: https://doi.org/10.1155/2019/4308462

Magra M, Maffulli N. Genetic aspects of tendinopathy. J Sci Med Sport 2008;11:243–7. DOI: https://doi.org/10.1016/j.jsams.2007.04.007

Mansur NSB, Furtado Fonseca L, Matsunaga FT, et al. Achilles Tendon Lesions – Part 1: Tendinopathies. Rev Bras Ortop 2020;55:657–64. DOI: https://doi.org/10.1055/s-0040-1702953

Belmoubarik A, Abouchane M, Mahraoui MA. Cas rare de rupture bilatérale des tendons d'Achille sans notion de tendinopathie ou de chirurgie de la cheville chez un jeune sportif: à propos d'un cas et revue de la literature [Rare case of bilateral rupture of the Achilles tendon with no notion of tendinopathy or ankle surgery in a young athlete: report of a case and review of literature]. Pan Afr Med J 2015;20:223. [Article in French] DOI: https://doi.org/10.11604/pamj.2015.20.223.5985

Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achilles tendinopathy: a systematic review. Foot Ankle Surg 2014;20:154–9. DOI: https://doi.org/10.1016/j.fas.2014.02.010

Majeed H, Deall C, Mann A, McBride DJ. Multiple intratendinous ossified deposits of the Achilles tendon: Case report of an unusual pattern of ossification. Foot Ankle Surg 2015;21:e33-5. DOI: https://doi.org/10.1016/j.fas.2014.12.001

Leumann A, Merian M, Valderrabano V. Ossification in chronic Achilles tendinosis: A third calf bone. Orthopade 2008;37:481–4. DOI: https://doi.org/10.1007/s00132-008-1222-8

Mady F, Vajda A. Bilateral ossification in the Achilles tendon: A case report. Foot Ankle Int 2000;21:1015–8. DOI: https://doi.org/10.1177/107110070002101206

Manfreda F, Ceccarini P, Corzani M, et al. A silent massive ossification of Achilles tendon as a suspected rare late effect of surgery for club foot. SAGE Open Med Case Rep 2018;6:2050313X18775587. DOI: https://doi.org/10.1177/2050313X18775587

Pedrotti, L., Bertani, B., Tuvo, G., Mora, R., Marin, L., & De Rosa, F. (2022). Achilles tendon surgery in clubfoot: Are long term sequelae predictable?. La Pediatria Medica E Chirurgica, 44(1). https://doi.org/10.4081/pmc.2022.280

Downloads

Download data is not yet available.

Citations