Scar characteristics of percutaneous Achilles tenotomy in Ponseti Technique-A cross-sectional study

Clubfoot, a common birth defect, is treated with the Ponseti method. It involves an intensive phase of weekly casting and Achilles tenotomy as the last step in most of the cases. The tenotomy scar of percutaneous Achilles tenotomy may cause aesthetic concerns that could affect parental satisfaction or impede footwear use. This study aims to objectively evaluate the scar characteristics of percutaneous Achilles tenotomy during Ponseti treatment and parental perception of the same.

This study enrolled children with idiopathic clubfoot treated by Ponseti protocol with percutaneous Achilles tenotomy before 1 year of age and on bracing protocol between 2 and 4 years. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS 2.0) were used to assess scar quality. Complications such as hypertrophy, keloid formation, brace difficulty, footwear difficulty, and walking difficulties were noted.

The study evaluated 82 scars in 50 children (35 males, 15 females). At the final follow-up, most of the scars were close to the normal skin. The mean value of the VSS and overall opinion of the observer and parents regarding the scar was 3.0 ± 1.0, 1.2 ± 0.5 and 2.2 ± 2.1 respectively. All children were able to walk using normal shoes and actively take part in outdoor activities and no complications such as hypertrophic scar or keloid formation were seen.

Percutaneous tenotomy causes minimal scarring and does not interfere with the general functioning of the child. The aesthetic characteristics of the scar are well-accepted by the parents. The use of percutaneous tenotomy should not be limited by the concern of a scar.