الفهرس 
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Abstract
Clubfoot is a relatively common congenital foot deformity. Ponseti demonstrated correction of clubfoot in infants using manipulation followed by application of well-molded, long-leg plaster casts.
Clubfoot, also termed congenital talipes equinovarus (CTEV), is a common foot abnormality, in which the foot points downward (equinus) and forefoot inward (metatarsus adductus) hind foot in (varus) mid foot in (cavus). The condition is present at birth. It is occurring in about one in every 1000 live births.
It is characterised by an excessively turned in foot (equinovarus) and high medial longitudinal arch (cavus), which if left untreated leads to long-term functional disability, deformity and pain. CTEV is thought to begin as the limb buds form and can be diagnosed on ultrasound from 12 weeks gestation. There are two types of CTEV: idiopathic (isolated) and syndromic (those associated with other syndromes or conditions). In both the cause is unknown, although hypotheses include associated transient gene activity, as seen in developmental dysplasia of the hips; neuromuscular disease; and lack of foetal movement. Emerging literature suggests a polygenic cause. Syndromic CTEV is often severe and more resistant to treatment.
There is nearly universal agreement that the initial treatment of the clubfoot should be non-operative regardless of the severity of the deformity. Historically, the treatment consists of forcible serial manipulation and casting with pressure applied over the calcaneocuboid joint as describe by the kite. If the deformity did not respond then most of the surgeons go through Postero-Medial Release of the soft tissue. Although all of these methods have the potential to be successful when applied correctly, most of the authors have reported a long-term success rate of only 15% to 50%. A notable exception is the Ponseti method which includes serial corrective manipulation, a specific technique of the cast application, and a possible percutaneous Achilles tenotomy.
The Ponseti treatment of clubfoot has three phases: the corrective phase involves application of casts, the maintenance phase where splint fitting is emphasized and the transition phase where the splints are discontinued and regular foot wear allowed. Problems can occur in any phase due to many causes: incorrect casting technique, improper tenotomy, under-corrected deformity, ill-fitting splints, and lack of understanding and poor compliance of patients’ parents due to poor socio-economy can all affect a successful outcome.
The aim of the current study was better management of club foot we performed this prospective randomized clinical study in Orthopedic outpatient clinic of Zagazig University hospitals which could be achieved through the following objectives;
1- To assess the clinical and radiological outcome of Achilles Tenotomy as a part of Ponseti technique.
2- To assess the incidence of complications that may occur with the procedure.
We found that;
- The present study included 12 children 15 feet with average age was 19.83±6.11 with minimum 12 and maximum 32 weeks, regard sex distribution male represent 58.3% and female 41.7%, 50% were right sided , 25% were left and 25.0% were bilateral.
- The Mean cast used in the current study was 7.41±1.08 with minimum 6 and maximum 9 casts as shown in table (5) there was significant decrease in mid and hind foot contracture score and total piriani from pre to 3 month of follow up and also significant decrease between pre and 6 months of follow up score but no significant difference founded between scores of 3 months and 6 months (2.58±0.51, 0.64±0.21 and 0.41±0.13), (2.54±0.39, 0.54±0.19 and 0.50±0.12) and (5.12±0.8, 1.08±0.37 and 0.91±0.32) respectively.
- Regarding radiological assessment talocalcaneal angle and lateral tibio calcaneal angle, Significant increase from pre to 3 month of follow up and also significant increase between pre and 6 months of follow up score but no significant difference founded between scores of 3 months and 6 months (20.8±1.5, 30.47±1.7 and 29.3±2.03) and (102.8±5.02, 62.47±4.5 and 63.46±7.5) respectively.
- Concerning the outcome, after completion of treatment in the present study, 13 feet had favorable outcome (8 cases (53.3%) excellent and 5 cases good 33.3%) and 2 feet had fair outcome (13.3); these 2 feet had relapse (13.3%), one foot relapsed equinus deformity and one adductus foot deformity, The equinus deformity patient responded to repeated tendo-achilles tenotomy and further Ponseti casting and adductus foot deformity responded to adductor tenotomy and cast. Both two cases obtained satisfactory outcome after completion of treatment. There was no significant association between the outcome and the children characteristics as shown in table (11,12,13).