European Journal of Molecular & Clinical Medicine

The standard Ponseti method is the optimum treatment of idiopathic CTEV which requires a serial manipulations and castings at weekly intervals. Few published results stated that the correction can be achieved in a significantly shorter time interval with multiple manipulations and castings per week.
Objective: This study was undertaken to compare the outcome of accelerated ponseti technique for idiopathic clubfoot by manipulations and casting done twice a week.
Materials & methods: A randomized comparative study was carried out for total 65 patients (80 clubfoot) attending the Outpatient department of Orthopaedics Sawai Man Singh Medical College and Hospital from 1st June, 2020 to 31st May, 2021. 40 clubfoots each in Standard Ponseti group and Accelerated Ponseti group were allotted according to computer generated randomisation plan. The method of manipulation was similar in both groups with once weekly casting in Standard Ponseti group and twice weekly casting in Accelerated Ponseti group. The initial and final Pirani scores, treatment time in plaster, number of casts required for correction, rate of tenotomy and relapse of deformity in the Standard and Accelerated Ponseti groups were documented and compared using paired and unpaired t-test methods as required.
Results: The two groups did not differ with respect to their initial and final Pirani scores of feet. The mean number of casts required was 4.88±1.8 in Standard Ponseti group, and 4.97±1.89 in Accelerated Ponseti group (p-value = 0.845NS). However, there was significant difference in the treatment time in plaster with mean treatment time of 35.636±14.54 in Standard Ponseti group and 23.625±15.03 days in Accelerated Ponseti group with p-value < 0.002S and 6 out of 33 feet in Standard Ponseti group and 8 out of 32 feet in Accelerated Ponseti group required percutaneous tenotomy. Relapse of equinus and adduction deformity was seen in 2 feet out of 33 in Standard ponseti group  and 3 out of 32 in Accelerated Ponseti groups on follow up.
Conclusion: The accelerated Ponseti method of treatment is a safe and effective method with twice a week manipulation. It significantly shortens the timeframe for the treatment and compliance of parents towards the treatment. The results obtained in our study showed good correction of deformity in shorter time interval when compared to standard method, which helps reducing economic concerns, cast complications and improving patients compliance.

Background: Traditionally Open Z-Plasty lengthening is the choice of the procedure for
treating Achilles tendon contracture seen in equinus deformity of the foot, which is
commonly seen in club foot, spastic cerebral palsy, polio myelitis, post traumatic and post
burn contractures etc. Percutaneous Achilles tendon lengthening by triple level tenotomy
technique is based on sliding of partially cut tendon preserving its biology, strength and
biomechanics. This study aims to evaluate the efficacy and safety of this new surgical
therapeutic method.
Methods: A retrospective analysis of the Achilles tendon contracture cases in our hospital
between 2015 and 2020 was conducted. Fifty-one cases of equinus deformities treated with
percutaneous triple level Achilles tendon tenotomy. Operative time required, hospital stay,
wound healing, Achilles tendon rupture and equinus recurrence were recorded and
statistically analysed. American Orthopaedic Foot & Ankle Society (AOFAS) scoring system
was used to assess the Foot and ankle function.
Results: The mean follow-up period was 20 months. The mean operative time was 6 minutes
and mean hospital stay was 2 days. No cases had infection or wound healing complications.
One patient had equinus recurrence which was minimal. The mean AOFAS score increased
from 53% points before procedure to 96% at final follow-up.
Conclusion: This method of Achilles tendon lengthening by Triple level percutaneous
tenotomy significantly reduces operative time, hospital stay and thus expenses. Also this
technique is much better in maintaining soft tissue biology, strength and biomechanics thus
helping in preventing rupture of the tendon and recurrence of the deformity.