The Association between Achilles Tendon Elasticity and Pirani Score with The Need for Achilles Tendon Lengthening in Patients with Congenital Talipes Equinovarus Post Ponseti Serial Casting

Backgrounds: Congenital Talipes Equinovarus (CTEV) is the most common congenital abnormalities in the musculoskeletal system. Currently there is no definite parameter to determine the necessity of surgery in CTEV. This study aimed to examine the association between Pirani score and the elasticity of achilles tendon with the need for Achilles Tendon Lengthening (ATL) in CTEV patient. Methods: This study is a prospective study which begins with calculating Pirani score and examining achilles tendon elasticity using Shear-Wave Elastography. The subject was performed ponseti serial casting and followed up for up to 6 weeks. After 6 weeks, an assessment was made to determine the necessity of ATL procedure based on the ability to perform 150 dorsiflexion. Data analysis was performed using SPSS version 22 to calculate receiver operating characteristic curve, spearman correlation test, and chi-square test. Results: There were a total of 33 feets included. Pirani score above 4.25 and achilles tendon elasticity above 19.39 kPa predicted the need of ATL. Correlation test showed moderate positive correlation between the Pirani score and the Achilles tendon elasticity score (r= 0.447; p = 0.009). There is an association between Pirani Score with surgery necessity (RR 4.52; 95%CI 1.52-13.45; p=0.001) and achilles tendon elasticity with surgery necessity (RR 9.625; 95% CI 2.54-36.35; p<0.001). Conclusion: There is an association between the Pirani score and achilles tendon elastography with the need of ATL procedures in CTEV patients. Both Pirani score and achilles tendon elastography are recommended to predict the need of ATL.