{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:44Z","timestamp":1783509284214,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Percutaneous Achilles tenotomy is an essential step in the Ponseti treatment of idiopathic clubfoot, with reported complications such as injury to the surrounding neurovascular structures and incomplete division of the Achilles tendon (AT). Knowledge of AT thickness would guide tenotomy blade insertion depth, obviating these related complications. We embarked on this study to ultrasonographically determine AT thickness at its different levels from the calcaneal insertion in children with idiopathic clubfoot.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective comparative study consisted of two groups of children 4 years and younger: a study group of patients with clubfoot requiring tenotomy and a control group. Both groups underwent ultrasonographic evaluation of their AT. The ultrasonographic data collected include AT thickness 1 and 2 cm from the calcaneal insertion of the AT, thickness of the thinnest portion of the tendon, and the distance of this thinnest portion from the calcaneal insertion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-seven children with idiopathic clubfoot constituted the study group, and 23 children with no musculoskeletal deformity were enrolled in the control group. Mean \u00b1 SD AT thicknesses 1 and 2 cm from the calcaneal insertion in the study group were 2.4 \u00b1 0.7 mm and 2.1 \u00b1 0.7 mm, respectively, and in the control group were 2.5 \u00b1 0.7 mm and 2.3 \u00b1 0.7 mm, respectively. The average thickness of the thinnest portion of the AT along its length was 2 mm at 1.8 cm from the calcaneal insertion in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Safe and complete percutaneous tenotomy would most likely be achieved when performed 1.8 cm from the calcaneal insertion, where the corresponding average AT thickness of 2 mm would be a guide to determine the insertion depth of the tenotomy blade.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/20-109","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T15:31:57Z","timestamp":1647358317000},"source":"Crossref","is-referenced-by-count":0,"title":["Determination of the Effective Site for Percutaneous Achilles Tenotomy in Ponseti Management of African Idiopathic Clubfoot"],"prefix":"10.3390","volume":"111","author":[{"given":"Olalekan A.","family":"Anipole","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence M.","family":"Oginni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwagbemiga O.","family":"Ayoola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olayinka O.","family":"Adegbehingbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwadare","family":"Esan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph O.","family":"Mejabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"apms-111-06-03-b01","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"448","DOI":"10.2106\/00004623-199274030-00021","article-title":"Treatment 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talipes equinovarus (clubfoot)","volume":"25","author":"Foster","year":"2007","unstructured":"Foster\n\t\t\t\t\t\t\tA\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tDavis\n\t\t\t\t\t\t\tN:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tCongenital talipes equinovarus (clubfoot).\n\t\t\t\t\tSurgery\n\t\t\t\t\t25: \n\t\t\t\t\t171,\n\t\t\t\t\t2007."},{"key":"apms-111-06-03-b04","series-title":"Iowa Orthop J","first-page":"22","article-title":"Results of the Ponseti method in patients with clubfoot associated with arthrogryposis","volume":"28","author":"Morcuende","year":"2008","unstructured":"Morcuende\n\t\t\t\t\t\t\tJA\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tDobbs\n\t\t\t\t\t\t\tMB\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tFrick\n\t\t\t\t\t\t\tSL:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tResults of the Ponseti method in patients with clubfoot associated with arthrogryposis.\n\t\t\t\t\tIowa Orthop J\n\t\t\t\t\t28: \n\t\t\t\t\t22,\n\t\t\t\t\t2008.\n\t\t\t\t19223944"},{"key":"apms-111-06-03-b05","series-title":"Iowa Orthop J","first-page":"7","article-title":"Ponseti clubfoot management: changing surgical trends in Nigeria","volume":"30","author":"Adegbehingbe","year":"2010","unstructured":"Adegbehingbe\n\t\t\t\t\t\t\tOO\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tOginni\n\t\t\t\t\t\t\tLM\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tOgundele\n\t\t\t\t\t\t\tOJ\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tPonseti clubfoot management: changing surgical trends in Nigeria.\n\t\t\t\t\tIowa Orthop J\n\t\t\t\t\t30: \n\t\t\t\t\t7,\n\t\t\t\t\t2010.\n\t\t\t\t21045965"},{"key":"apms-111-06-03-b06","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"23","DOI":"10.2106\/00004623-198062010-00004","article-title":"Long-term results of treatment of congenital club 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\n\t\t\t\t\t19,\n\t\t\t\t\t2016.\n\t\t\t\t10.1007\/s11832-016-0710-326825454http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000378156600003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"apms-111-06-03-b18","series-title":"J West Afr Coll Surg","first-page":"65","article-title":"Experience with Ponseti protocol and achilles tenotomy in the management of clubfoot at the Lagos State University Teaching Hospital, Lagos, Nigeria","volume":"7","author":"Adewole","year":"2017","unstructured":"Adewole\n\t\t\t\t\t\t\tA\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWilliams\n\t\t\t\t\t\t\tOM\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tShoga\n\t\t\t\t\t\t\tMO\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tExperience with Ponseti protocol and achilles tenotomy in the management of clubfoot at the Lagos State University Teaching Hospital, Lagos, Nigeria.\n\t\t\t\t\tJ West Afr Coll Surg\n\t\t\t\t\t7: \n\t\t\t\t\t65,\n\t\t\t\t\t2017.\n\t\t\t\t29951466"},{"key":"apms-111-06-03-b19","series-title":"Int J Recent Sci Res","first-page":"5665","article-title":"Redevelop of Achilles tendon after percutaneous tenotomy in idiopathic clubfoot patients as per Ponseti's method of correction clinically and using two needle","volume":"6","author":"Gupta","year":"2015","unstructured":"Gupta\n\t\t\t\t\t\t\tGK\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRani\n\t\t\t\t\t\t\tS\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSahu\n\t\t\t\t\t\t\tC\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tRedevelop of Achilles tendon after percutaneous tenotomy in idiopathic clubfoot patients as per Ponseti's method of correction clinically and using two needle.\n\t\t\t\t\tInt J Recent Sci Res\n\t\t\t\t\t6: \n\t\t\t\t\t5665,\n\t\t\t\t\t2015."},{"key":"apms-111-06-03-b20","series-title":"Int J Res Orthop","first-page":"52","article-title":"Management of idiopathic clubfoot by Ponseti's method: a comparative clinical study on toddlers with radiological correlation","volume":"2","author":"Kumar","year":"2016","unstructured":"Kumar\n\t\t\t\t\t\t\tR\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tPriya\n\t\t\t\t\t\t\tA:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tManagement of idiopathic clubfoot by Ponseti's method: a comparative clinical study on toddlers with radiological correlation.\n\t\t\t\t\tInt J Res Orthop\n\t\t\t\t\t2: \n\t\t\t\t\t52,\n\t\t\t\t\t2016."},{"key":"apms-111-06-03-b21","series-title":"J Child Orthop","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s11832-009-0179-4","article-title":"Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired?","volume":"3","author":"Ippolito","year":"2009","unstructured":"Ippolito\n\t\t\t\t\t\t\tE\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tDe Maio\n\t\t\t\t\t\t\tF\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMancini\n\t\t\t\t\t\t\tF\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tLeg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired?\n\t\t\t\t\tJ Child Orthop\n\t\t\t\t\t3: \n\t\t\t\t\t171,\n\t\t\t\t\t2009.\n\t\t\t\t10.1007\/s11832-009-0179-4"},{"key":"apms-111-06-03-b22","series-title":"The Achilles Tendon","first-page":"5","article-title":"\u201cThe Anatomy of the Achilles Tendon,\u201d","author":"Benjamin","year":"2007","unstructured":"Benjamin\n\t\t\t\t\t\t\tM\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tTheobald\n\t\t\t\t\t\t\tP\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSuzuki\n\t\t\t\t\t\t\tD\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\t\u201cThe Anatomy of the Achilles Tendon,\u201d\n\t\t\t\t\tin\n\t\t\t\t\tThe Achilles Tendon, \n\t\t\t\t\ted by\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMaffulli,\n\t\t\t\t\t\t\tN\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAlmekinders,\n\t\t\t\t\t\t\tL\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tp\n\t\t\t\t\t5,\n\t\t\t\t\tSpringer-Verlag,\n\t\t\t\t\tLondon,\n\t\t\t\t\t2007."},{"key":"apms-111-06-03-b23","series-title":"Radiol Bras","first-page":"141","article-title":"Measurements of the calcaneal tendon in the first year of life","volume":"42","author":"Bezerra","year":"2009","unstructured":"Bezerra\n\t\t\t\t\t\t\tRFA\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tCampos\n\t\t\t\t\t\t\tJD\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBezerra\n\t\t\t\t\t\t\tVLVA\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tMeasurements of the calcaneal tendon in the first year of life.\n\t\t\t\t\tRadiol Bras\n\t\t\t\t\t42: \n\t\t\t\t\t141,\n\t\t\t\t\t2009."},{"key":"apms-111-06-03-b24","series-title":"Radiol Bras","first-page":"61","article-title":"Morphometric evaluation of Achilles tendon by ultrasound","volume":"39","author":"de Mello","year":"2006","unstructured":"de Mello\n\t\t\t\t\t\t\tRAF\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tMarchiori\n\t\t\t\t\t\t\tE\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tdos Santos\n\t\t\t\t\t\t\tAASMD\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tMorphometric evaluation of Achilles tendon by ultrasound.\n\t\t\t\t\tRadiol Bras\n\t\t\t\t\t39: \n\t\t\t\t\t61,\n\t\t\t\t\t2006."},{"key":"apms-111-06-03-b25","series-title":"Surg Radiol Anat","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/BF01795061","article-title":"Anatomy of the Achilles tendon (tendo calcaneus) with respect to tendon thickness measurements","volume":"17","author":"Koivunen-Niemel\u00e4","year":"1995","unstructured":"Koivunen-Niemel\u00e4\n\t\t\t\t\t\t\tT\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tParkkola\n\t\t\t\t\t\t\tK:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tAnatomy of the Achilles tendon (tendo calcaneus) with respect to tendon thickness measurements.\n\t\t\t\t\tSurg Radiol Anat\n\t\t\t\t\t17: \n\t\t\t\t\t263,\n\t\t\t\t\t1995.\n\t\t\t\t10.1007\/BF017950617502192"}],"container-title":["Journal of the American Podiatric Medical 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