İdiyopatik Pes Ekinovaruslu Yenidoğanlarda Erken Yapılan Aşilotominin Dimeglio Sınıflamasına Göre Değerlendirilmesi

Abstract

ABSTRACT

Mutlu, E., Assessment of Early Achillotomy in the Newborn Idiopathic Pes Equinovarus According to Dimeglio Classification, Hacettepe University Faculty of Medicine, Thesis in Orthopaedics and Traumatology. Ankara 2018. Ponseti method is gold standard in congenital pes equinovarus (PEV) treatment. The classical Ponseti method consists of tenotomy of the achilles tendon following serial casting. In this study, we aimed to evaluate the clinical and radiological results of early achillotomy which was applied before Ponseti plastering in untreated newborns with typical PEV deformities and to investigate the effect of early achillotomy on the number of casting. Thirty patients (43 feet) were treated with early achillotomy and Ponseti plastering technique. Four patients (6 feet) were removed from the study due to teratological PEV. PEV deformities were evaluated using the Dimeglio classification. The study group included those with Dimeglio type 3 and type 4 deformities. Unlike the classical Ponseti method, pre-cast achillotomy was performed in the treatment. In the follow-up period, the patients were plastered with Ponseti method. After the plastering, the patients’ treatment continued with the foot abduction splints. Follow-up of the foot deformities were assessed with the Dimeglio scoring clinically, and with lateral talocalcaneal and tibiocalcaneal angles radiologically. The median age of the patients at the time of the achillotomy was 14 days (4-37 days). Twenty of the patients were male and 6 were female. There were 11 bilateral and 15 unilateral deformities. The average follow-up period was 12 months (7-18 months). The mean Dimeglio score before the achillotomy was 14.4 (11-16) for the right feet and 13.6 (10-16) for the left feet. At the 6th month follow-up the last Dimeglio scores were 4.2 (4-6) for the right feet and 4.2 (4-6) for the left feet. The mean casting number was 3.8  0.4 for right feet and 3.7  0.4 for left feet. The mean talocalcaneal angle was 24  8.2 degrees for the right feet and 27  8.2 degrees for the left feet. The mean tibiocalcaneal angle was 69.1  12.9 for the right feet and 72  14 degrees for the left feet. Idiopathic PEV with early achillotomy and Ponseti plaster technique can achieve effective clinical and radiological results. The number of casting was decreased when compared with the classical Ponseti plastering technique in the literature. This case is time-saving, reduces the cost of the therapy and also the concerns of the parents about the treatment. Keywords: Pes equinovarus, Dimeglio, Ponseti method, conservative treatment