Does the use of ultrasound guidance during percutaneous Achilles tendon tenotomy improve outcomes of clubfoot management?
Abstract
A prospective RCT challenging the utility of ultrasound guidance for Achilles tenotomy in clubfoot. Data confirms the traditional blind technique is equally safe and effective, rendering image guidance unnecessary.
Blind Technique Remains Gold Standard
Key Finding
"Ultrasound guidance added operative time but offered no reduction in complications (p = 0.56) or improvement in functional Pirani scores."
Background: Percutaneous Achilles Tenotomy (PAT) is a cornerstone of the Ponseti method. While traditionally performed blindly via palpation, concerns regarding iatrogenic neurovascular injury have driven some surgeons toward ultrasound (US) guidance. This study sought to determine if the added cost and time of US guidance yielded measurable clinical safety benefits.
Methods: A single-center RCT randomized 50 patients (74 clubfeet) to either US-guided PAT (n = 25) or conventional blind PAT (n = 25). The procedure was performed under local anesthesia. Primary endpoints included complication rates (bleeding, nerve injury, incomplete tenotomy) and FLACC pain scores. Secondary endpoints were Pirani scores at 1-year follow-up.
Results: There was no statistically significant difference in complication rates between groups (p = 0.557). Minor bleeding occurred in 11.1% of the US group vs. 15.8% of the control group. Zero nerve injuries occurred in either cohort. Interestingly, FLACC pain scores were slightly higher in the control group (p = 0.03), but functionally, all feet in both groups achieved a Pirani score of zero with no relapses at 1 year.
Conclusion: Routine ultrasound guidance for Achilles tenotomy is clinical over-engineering. It increases procedural time without enhancing safety or efficacy. The palpation-guided blind technique remains the efficient, safe standard of care for idiopathic clubfoot.