Effectiveness of Percutaneous Needle Achilles Tenotomy for Correction of Equinus Deformity in Idiopathic Congenital Clubfoot: A Prospective Observational Study

Background: Ponseti casting and manipulation are the cornerstone treatments for idiopathic congenital talipes equinovarus (CTEV). While cavus, adduction, and varus deformities are typically corrected with serial casting, equinus deformity often persists and requires Achilles tendon tenotomy. Percutaneous tenotomy using a scalpel blade is effective but carries a risk of neurovascular injury. Objective: This study aimed to evaluate the effectiveness and safety of percutaneous needle Achilles tendon tenotomy in correcting equinus deformity in children with idiopathic congenital clubfoot. Methodology: This prospective observational study included 16 patients (27 clubfeet) with idiopathic congenital clubfoot treated at a tertiary care orthopedic unit between February and August 2024. All patients had residual equinus deformity following serial Ponseti casting. Percutaneous Achilles tenotomy was performed using an 18-gauge needle under local anesthesia. The primary outcome was ankle dorsiflexion measured at three months post-procedure. Secondary outcomes included dorsiflexion at cast removal and procedure-related complications. Statistical analysis was conducted using paired comparisons. Results: The mean pre-tenotomy equinus deformity was 29.7° (range 20–42°). At final cast removal, mean ankle dorsiflexion improved to 23.1° (range 18–36°) and was maintained at three months (mean 23.4°). The improvement from baseline was statistically significant (p < 0.001). No intraoperative or postoperative complications were observed. Conclusion: Percutaneous needle Achilles tendon tenotomy is a simple, safe, and effective technique for achieving correction of equinus deformity in idiopathic congenital clubfoot, with excellent short-term outcomes and no observed complications. Keywords: Achilles Tendon, Clubfoot, Equinus, Needle Tenotomy.