Ultrasonographic observation of the healing process in the gap after a Ponseti-type Achilles tenotomy for idiopathic congenital clubfoot at two-year follow-up
Ponseti 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 two years after Ponseti-type Achilles tenotomy in patients with clubfeet.
We conducted an ultrasonographic study to clarify the sequential changes in gap healing for up to two years 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 12 weeks as well as at 4, 6, 12, 18, and 24 months after tenotomy.
Continuity and gliding were noted within four weeks. The united portion continued to thicken for up to three months after tenotomy. Starting from the fourth month, the healed portion began to lose its thickness, and this process continued into the sixth month. At one year, 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 two years 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.
To our knowledge, our results are the first to describe the process of gap healing in the tendon after tenotomy up to and beyond two years, as recommended in the Ponseti bracing protocol.
Level of evidence IV.
- Herzenberg, JE, Radler, C, Bor, N (2002) Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 22: pp. 517-521
- Ponseti, IV (1996) Congenital clubfoot: fundamentals of treatment. Oxford University Press, New York
- Colburn, M, Williams, M (2003) Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg 42: pp. 259-267 CrossRef
- Scher, DM, Feldman, DS, Bosse, HJ, Sala, DA, Lehman, WB (2004) Predicting the need for tenotomy in the Ponseti method for correction of clubfoot. J Pediatr Orthop 24: pp. 349-352 CrossRef
- Morcuende, JA, Abbasi, D, Dolan, LA, Ponseti, IV (2005) Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 25: pp. 623-626 CrossRef
- Bor, N, Herzenberg, JE, Frick, AL (2006) Ponseti management of clubfoot in older infants. Clin Orthop Relat Res 444: pp. 224-228 CrossRef
- Bor, N, Coplan, JA, Herzenberg, JE (2009) Ponseti treatment for idiopathic clubfoot. Minimum 5-year followup. Clin Orthop Relat Res 467: pp. 1263-1270 CrossRef
- Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg (Am). 2004;86:22–7.
- Gheledere, A, Docquier, PL (2008) Analytical radiography of clubfoot after tenotomy. J Pediatr Orthop 28: pp. 691-694 CrossRef
- Baker SL, Lavy CB. Correction of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. J Bone Joint Surg (Br). 2006;88:377–9.
- Niki H, Watanabe G, Hirano T, Tanaka T, Okada H, Beppu M, Nakajima H. Ultrasonographic observation of the healing process after Achilles tenotomy in congenital clubfoot: a preliminary report. J Jpn Soc Surg Foot. 2008;29(2):104–8 (in Japanese).
- Maranho, DA, Nougueir-Barbosa, MH, Simao, MN, Volpon, JB (2009) Ultrasonographic evaluation of Achilles tendon repair after percutaneous sectioning for the correction of congenital clubfoot residual equines. J Pediatr Orthop 29: pp. 804-810 CrossRef
- Mangat KS, Kanwar T, Johnson K, Korah G, Prem H. Ultrasonographic phases in gap healing following Ponseti-type Achilles tenotomy. J Bone Joint Surg (Am). 2010;92:1462–7.
- Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJ, Iannacone M, Bazzi JS, Feldman DS. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop (B). 2003;12:133–40.
- Potenza AD. Critical evaluation of flexor-tendon healing and adhesion formation within artificial digital sheaths. J Bone Joint Surg (Am). 1963;45:1217–33.
- Lin, TW, Cardenas, L, Soslowsky, LJ (2004) Biomechanics of tendon injury and repair. J Biomech 37: pp. 865-877 CrossRef
- Ingraham, JM, Hauck, RM, Ehrlich, HP (2003) Is the tendon embryogenesis process resurrected during tendon healing?. Plast Reconstr Surg 112: pp. 844-854 CrossRef
- Ultrasonographic observation of the healing process in the gap after a Ponseti-type Achilles tenotomy for idiopathic congenital clubfoot at two-year follow-up
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of Orthopaedic Science
Volume 18, Issue 1 , pp 70-75
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links