Abstract
Purpose: The main purpose of the study is to present our experience with the Ponseti casting followed by an Achilles tendon (AT) tenotomy in children with arthrogryposis multiplex congenita (AMC).
Methods: 7 children with 14 severe clubfeet were treated by us with a Ponseti manipulations and casting followed by AT tenotomy. 5 children (10 feet) were followed at least 24 months after the AT tenotomy and were selected for the final evaluation. Their mean age at follow up was 38,4 months and average follow up period was 35,8 months. The treatment was begun within first month of life, the AT tenotomy to correct rigid equinus was performed at 14,4 weeks of life on average, after 7–10 cast changes (mean 8,4). Niki H. et al. clinical criteria and standard standing AP and lateral radiographs were analyzed for final evaluation.
Results: There were 7 feet with clinically satisfactory results. Among 3 unsatisfactory feet there were two (1 child) with rocker-bottom pseudocorrections after repeated bilateral AT tenotomies and one recurrent clubfoot (1 child). Six feet required in soft tissue releases in 3, 12 and 21 months after the AT tenotomy due moderate equinus and adductus. 3 feet underwent repeated AT tenotomies in 6 and 15 months after the primary procedure. The mean interval between initial AT tenotomies and redo surgical procedures was 10,5 months (range 3–21 months). Two feet (20%) remain without significant deformity after AT tenotomies.
Conclusion: Clubfeet in AMC respond initially to the Ponseti method of casting and the deformity may be corrected or diminished. In some children wide surgical treatment can be avoided, in other delayed. Despite necessity for additional surgical intervention, the Ponseti method of casting and Achilles tenotomy does seem to be an alternative for initial treatment in children with AMC.
Correspondence should be addressed to BSCOS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
