Effect of physiotherapy on frequency of achilles tendon tenotomy in treatment of congenital talipes equinovarus (Club Foot).

Objective: To evaluate the effect of physiotherapy on frequency of Achilles tendon tenotomy in the treatment of congenital talipes equinovarus (club foot). Study Design: Prospective, Interventional, Cross-sectional study. Setting: Orthopedic Club-Foot Outpatient Department, Jinnah Postgraduate Medical Center, Karachi. Period: June 2024 to November 2024. Methods: Included 50 children (100 feet) under six months of age diagnosed with idiopathic CTEV. Patients were divided into two groups: one receiving structured physiotherapy before casting and the other receiving standard Ponseti treatment. The primary outcome was the frequency of Achilles tendon tenotomy. Results: Among feet that did not require tenotomy, 62.1% were from the physiotherapy group (p = 0.009). Single tenotomy was more common in the control group (63.4%) compared to the physiotherapy group (36.6%), while all repeat tenotomies occurred in the control group. Subgroup analysis showed significant reduction in tenotomy in patients aged 0–12 weeks, males, unilateral cases, and those with or without family history. Conclusion: Pre-casting physiotherapy significantly reduces the need for Achilles tendon tenotomy in infants with idiopathic CTEV. Its integration into routine Ponseti protocol may enhance treatment outcomes and reduce surgical burden, particularly in resource-constrained settings.