Re: tenotomy vs. heel cord lengthening

[Guest guest]

Callie,

Here's the definition from my website's FAQs #3

(http://ponseticlubfoot.freeservers.com/faq.html):

" A tenotomy is a subcutaneous (under the skin) sectioning of the

Achilles tendon. As a part of the final casting appointment, a

scalpel is used to make a small incision in the back of the ankle

under local anesthetic (some doctors use general anesthetic) to

lengthen the Achilles tendon. The incision is so small that stitches

are not needed. This procedure is intended to complete the

correction of the equinus of the foot (allow the toes to lift and the

heel to drop). This in-office procedure is needed in approximately

75% of cases treated with the Ponseti method. The final cast is left

on for 3 weeks to allow the tendon to heal completely. There are

some other types of tenotomies used by other physicians that are more

involved than the procedure described here. An open incision heel

cord lengthening would need to be done under a general anesthesia

where the Achilles tendon is cut in a z-lengthening procedure and

stitched back together with extra length. When done, casts need to be

worn for about 6 weeks while it heals. The 3rd way the Achilles

tendon is lengthened is as a part of a posterior release type

procedure. This begins with an open incision Achilles tendon

lengthening and then the doctor usually cuts, lengthens up to 5 other

ligaments/joints. Then if that isn't sufficient to correct the foot,

the doctor can proceed with additional release types of procedures

called medial, lateral and plantar releases. These releases involve

up to an additional 25-30 things being cut, lengthened, etc. A

release type of procedure is what the Ponseti method only needs to do

about 2% of the time. The procedures that can be done as a part of a

Posterior release or the other types of releases are defined at the

Wheeless Textbook of Orthopedics at

http://www.medmedia.com/o14/120.htm When a release type of procedure

is done, casts need to be worn for about 10-12 weeks to allow for

healing. For many doctors, the casts are changed at least once during

that period. "

Tenotomy is the technical word for heel cord lengthening.

The specific tenotomy procedure used by Ponseti doctors is the

subcutaneous tenotomy that requires no stitches to close. Other

tenotomies such as the z-lengthening are open-incision and more

involved.

Are you able to seek a second opinion from a qualified Ponseti

doctor? The fact that your son is continually slipping in his casts

indicates to me that something isn't quite right with your doctor's

technique (if they claim to be using the Ponseti method).

The tenotomy is usually the last step in achieving correction.

You can see photos of my daughter's heel area after we removed the

cast 3 weeks after her tenotomy at the above mentioned website in the

photo gallery. There's not much to see.

I hope this helps-

& (3-16-00)

left clubfoot, switched to Ponseti method at 4 months old

> Could someone please explain the difference in a tenotomy and heel

> cord lengthening? My doctor told me that after a few more

castings,

> my 2 1/2 mo. old son would probably have the tenotomy on his right

> foot redone (he has BL clubfoot). After kicking his cast off for

the

> second time on that side in 4 days, we returned again today and the

> doctor now tells me that they will probably have to use general

> anesthesia and he'll have a heel cord lengthening procedure. He

said

> something about a " Z " incision. I was confused. Is this tendon

> lengthening part of the ponseti method? I'm a little nervous.

[Guest guest]

Callie,

Simon had what his doctor called a heel cord release. He also called it a

heel cord lengthening. His was done under general anesthia. It was three

small incisions that required NO stiches. He said he was just going to snip

the tendon. He was not put in cast though. He was bandaged and then put a

piece of padding under the top of his foot to keep it up; he was then put

back in his afo's. He will have to keep the padding elevating the top part

of his foot for six weeks. I was hoping for cast, but after it was done I

was glad he didn't because he bled a little more than I would have liked. It

was a peace of mind because I could see that his heel wasn't bleeding too

bad. Don't get scared because he didn't bleed enormus amounts, but it was a

little over a fifty cent piece, and they just said to put more bandage on

it. Simon had this done Tuesday and he has been fine since Wednesday. A

little fussy but not in pain. If it is just a simple proecdure I wouldn't

worry. Just make sure you know what the doctor is actually going to do.

Sorry for the rambling.

& Simon

>

>Reply-To: nosurgery4clubfoot

>To: nosurgery4clubfoot

>Subject: Re: tenotomy vs. heel cord lengthening

>Date: Fri, 21 Nov 2003 00:02:23 -0000

>

>Callie,

>Here's the definition from my website's FAQs #3

>(http://ponseticlubfoot.freeservers.com/faq.html):

> " A tenotomy is a subcutaneous (under the skin) sectioning of the

>Achilles tendon. As a part of the final casting appointment, a

>scalpel is used to make a small incision in the back of the ankle

>under local anesthetic (some doctors use general anesthetic) to

>lengthen the Achilles tendon. The incision is so small that stitches

>are not needed. This procedure is intended to complete the

>correction of the equinus of the foot (allow the toes to lift and the

>heel to drop). This in-office procedure is needed in approximately

>75% of cases treated with the Ponseti method. The final cast is left

>on for 3 weeks to allow the tendon to heal completely. There are

>some other types of tenotomies used by other physicians that are more

>involved than the procedure described here. An open incision heel

>cord lengthening would need to be done under a general anesthesia

>where the Achilles tendon is cut in a z-lengthening procedure and

>stitched back together with extra length. When done, casts need to be

>worn for about 6 weeks while it heals. The 3rd way the Achilles

>tendon is lengthened is as a part of a posterior release type

>procedure. This begins with an open incision Achilles tendon

>lengthening and then the doctor usually cuts, lengthens up to 5 other

>ligaments/joints. Then if that isn't sufficient to correct the foot,

>the doctor can proceed with additional release types of procedures

>called medial, lateral and plantar releases. These releases involve

>up to an additional 25-30 things being cut, lengthened, etc. A

>release type of procedure is what the Ponseti method only needs to do

>about 2% of the time. The procedures that can be done as a part of a

>Posterior release or the other types of releases are defined at the

>Wheeless Textbook of Orthopedics at

>http://www.medmedia.com/o14/120.htm When a release type of procedure

>is done, casts need to be worn for about 10-12 weeks to allow for

>healing. For many doctors, the casts are changed at least once during

>that period. "

>

>Tenotomy is the technical word for heel cord lengthening.

>The specific tenotomy procedure used by Ponseti doctors is the

>subcutaneous tenotomy that requires no stitches to close. Other

>tenotomies such as the z-lengthening are open-incision and more

>involved.

>Are you able to seek a second opinion from a qualified Ponseti

>doctor? The fact that your son is continually slipping in his casts

>indicates to me that something isn't quite right with your doctor's

>technique (if they claim to be using the Ponseti method).

>The tenotomy is usually the last step in achieving correction.

>You can see photos of my daughter's heel area after we removed the

>cast 3 weeks after her tenotomy at the above mentioned website in the

>photo gallery. There's not much to see.

>I hope this helps-

> & (3-16-00)

>left clubfoot, switched to Ponseti method at 4 months old

>

>

>

> > Could someone please explain the difference in a tenotomy and heel

> > cord lengthening? My doctor told me that after a few more

>castings,

> > my 2 1/2 mo. old son would probably have the tenotomy on his right

> > foot redone (he has BL clubfoot). After kicking his cast off for

>the

> > second time on that side in 4 days, we returned again today and the

> > doctor now tells me that they will probably have to use general

> > anesthesia and he'll have a heel cord lengthening procedure. He

>said

> > something about a " Z " incision. I was confused. Is this tendon

> > lengthening part of the ponseti method? I'm a little nervous.

>

>

>

>