Abstract
BackgroundPonseti management usually requires Achilles tenotomy during the final stage of serial casting. However, we lack a good understanding of the sequential tendon healing process after tenotomy in the Ponseti bracing protocol. The purpose of this study was to clarify the ultrasonographic process of tendon healing in the gap for up to twoyears after Ponseti-type Achilles tenotomy in patients with clubfeet. MethodsWe conducted an ultrasonographic study to clarify the sequential changes in gap healing for up to twoyears after tenotomy. The subjects were 23 patients with 33 clubfeet. Achilles tenotomy was performed at mean 10.4 (8–16) weeks after birth. Dynamic and static ultrasonography was performed before tenotomy and at 1, 2, 3, 4, 6, 8, and 12weeks as well as at 4, 6, 12, 18, and 24months after tenotomy. ResultsContinuity and gliding were noted within fourweeks. The united portion continued to thicken for up to threemonths after tenotomy. Starting from the fourth month, the healed portion began to lose its thickness, and this process continued into the sixth month. At oneyear, the thickness of the tendon did not differ much from that of the tendon on the opposing foot. In cases where patients had clubfoot on both feet and underwent simultaneous tenotomies, measurement of the tendons could not be accurately compared. At twoyears after tenotomy, slight irregularity of the internal structure persisted when compared with the unaffected foot. In addition, clinical and X-ray findings were evaluated simultaneously, and no recurrence was confirmed. ConclusionsTo our knowledge, our results are the first to describe the process of gap healing in the tendon after tenotomy up to and beyond twoyears, as recommended in the Ponseti bracing protocol.Level of evidence IV.
Highlights
The Ponseti method is a well-established treatment for idiopathic congenital clubfoot deformity [1, 2]
The purpose of this study was to clarify the ultrasonographic process of tendon healing in the gap for up to two years after Ponseti-type Achilles tenotomy in patients with clubfeet
The Ponseti method consists of three phases; manipulation followed by weekly serial casting as the first phase, Achilles tenotomy and post-tenotomy casting as the second phase, and a bracing protocol as the third phase [2]
Summary
The Ponseti method is a well-established treatment for idiopathic congenital clubfoot deformity [1, 2]. The Ponseti method consists of three phases; manipulation followed by weekly serial casting as the first phase, Achilles tenotomy and post-tenotomy casting as the second phase, and a bracing protocol as the third phase [2]. Several studies found that 85 % of Achilles tenotomies were performed by the Ponseti method [1, 5,6,7,8]. We lack a good understanding of the sequential tendon healing process after tenotomy in the Ponseti bracing protocol. The purpose of this study was to clarify the ultrasonographic process of tendon healing in the gap for up to two years after Ponseti-type Achilles tenotomy in patients with clubfeet
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