Comparative Study between Percutaneous Elongation and Z- Lengthening of Tight Achilles Tendon in Idiopathic Toe Walking Children

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Department of orthopedic surgery, Faculty of Medicine For Boys, Al-Azhar University, Cairo, Egypt.

Abstract

Background: Idiopathic toe-walking is a gait pattern in which the child walks on the balls of their feet or their toes without touch of the heel to the ground, in the absence of known medical conditions as neuromuscular problems. Objective: To compare between the two surgical methods for lengthening of Achilles tendon in idiopathic toe walking children with tight heel cord, regarding technique of the operation, post-operative complication rates, functional results and advantages of one technique over the other. Materials and Methods: A prospective study was done in the Hospitals of Al-Azhar University (Bab El Shaerrya, and Al-Hussein Hospitals), between October 2022 to May 2023, on idiopathic toe walking children with tight heel cord undergone surgery for elongation of Tendo Achilles, we chose two methods of lengthening, Open and Percutaneous. Results: All patients had excellent functional and satisfaction outcome except 3 cases had fair satisfaction due to recurrence (inappropriate postoperative protocol): 2 feet of those treated by open technique (group B), 1 foot of those treated by percutaneous technique (group A). As regard complications no reported complications, except one foot which had superficial infection in group B, and improved after serial dressing and antibiotics, our follow-up period was six months postoperatively. Conclusion: The technique of Percutaneous elongation technique is recommended than Open Z-lengthening technique for treatment of (ITW) children with tight heel cord, because it produced excellent results in terms of safety, useful result, satisfaction, and the avoidance of additional morbidities of surgical site.

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