Confirmation of Tenotomy Healing at 3 Weeks Using the Ponseti Protocol

Percutaneous Achilles tenotomy is an integral key element of the Ponseti method in clubfoot management. The duration of posttenotomy casting has been empirical. Evidence-based duration of healing in Achilles tendon is required to objectively determine the period of posttenotomy casting. This study aims to use clinical and ultrasonographic methods to evaluate the mean duration of Achilles tendon gap (ATG) closure and the weekly percentage of feet that achieved ATG closure after tenotomy. Prospectively, 37 feet of 25 patients <5 years old with idiopathic clubfoot were managed using Ponseti methods. The Achilles tendon was assessed clinically and ultrasonographically before and after tenotomy. The tendon stump gap was created at tenotomy, and posttenotomy assessments were done on a weekly basis until tendon stump gap closure was achieved, with a minimum follow-up of 2 years. The immediate posttenotomy ultrasonographic mean tendon gap area was 5 ± 2.8 mm. The mean duration of the tendon stump gap closure as determined clinically was 1.9 ± 0.8 weeks, whereas it was 2.6 ± 0.9 weeks as assessed ultrasonographically (p < .001). The significant difference between clinical and ultrasound methods of assessing the Achilles tendon gap closure appears to establish casting removal and ambulatory walking at 3 weeks after tenotomy for <5-year-old children with idiopathic clubfoot treated with the Ponseti method. We recommend that the duration of posttenotomy cast should be 3 weeks based on the ultrasonographic findings.