Re: Second Tenotomies

September 17, 2004

Here are my opinions concerning your questions.

1. I don't think that there have been any long term studies on

second tenotomies. Over the years, there have been a number of

parents who have mentioned that Dr. Ponseti indicated that it was

possible that they may need a second tenotomy. Usually, that was if

they were coming from a prior treatment elsewhere that had included

at tenotomy. Usually, when parents went to Iowa, they were able to

get the feet corrected without a second tenotomy. A while ago,

there was a poll here to see how many parents actually had a second

tenotomy. The poll was located at

http://health.groups.yahoo.com/group/nosurgery4clubfoot/surveys?

id=610474

2. P.T. may improve the flexibility of the feet, but Dr. Ponseti has

specifically indicated that he does not recommend it. My guess is

that he would be concerned about the P.T. being done in a way that

creates a problem the foot. Over the past 50 years, Dr. Ponseti has

not felt that P.T. was needed to make his method work.

3. Age limit on tenotomies? Tenotomies are an accepted form of

treatment, but there have probably not been many done for children

over 2 years of age. There are some studies on the interenet of

tenotomies of other tendons in adults, but I haven't looked at them

for a number of years.

4. If a lengthening of the achilles tendon is required, it is

possible that P.T. may improve it. Otherwise, the tendon could be

lengthened by recasting, perahps by adjusting the FAB/DBB, a second

tenotomy or some type of open incision lengthening of the achilles

tendon.

5. I don't think that a 2nd tenotomy will increase the need for

further tenotomies.

and (3-17-99)

> Hi All,

>

> Haven't posted or even lurked in quite some time, so I've missed a

> lot of discussion here. My Sophia (12/8/03 -- 9 months old) has

> bicf, was treated by Dr. Ponseti, and has been in the

shoes

> since about 2 months. All has thus far gone seamlessly and her

feet

> look really good. However, my husband and I feel that her heel

seems

> to be tightening up. We have a check up in late October with Dr.

> Ponseti, but I want to do my homework ahead of time. I have a few

> questions that I'd really appreciate feedback on. Here goes:

>

> 1) Has there been any long-term research on second tenotomies?

Does

> it weaken their feet/ankles by having this procedure done more

than

> once? I'm looking for the pros and cons.

>

> 2) Has anyone had good success with PT to improve

> flexibility/dorsiflection of the feet?

>

> 3) Is there an age limit on doing the tenotomies before the

tendon

> doesn't regenerate anymore? One year, eighteen months?

>

> 4) If her dorsiflection is greatly diminished from what it was,

do I

> have any other options than a second tenotomy?

>

> 5) If she has a second tenotomy, does that increase the likihood

> that she will also need subsequent ones?

>

> I'm just wondering if we should start PT for this even before our

> check up with Dr. Ponseti. Or perhaps, if Sophia does need a

second

> tenotomy, maybe PT is a good thing to do to possibly prevent any

> future tightening. I'm starting to get really worried about

this.

> I'd really hate for her cf to interfere with her future

participation

> in sports of any kind. Any feedback is appreciated.

>

> Thanks in advance,

>

> mom to Sophia 12/8/03 bicf

September 17, 2004

Hi,

I'm sorry you have this worry.. Sometimes I think it's hard to tell

how much dorsiflexion there is. It does seem to change as they grow,

and might not necessarily indicate a developing problem.

I also have learned that a huge amount of dorsiflexion is not

required to still have good function. My 4 yr old daughter's isn't

nearly as much as her normal foot, yet she does just fine. So, I hope

that it all turns out to be nothing to be concerned about.

If it is, though, I have heard of relapse situations in which a

second tenotomy has been anticipated, but then the loss of

dorsiflexion was handled successfully with casting alone. See this

message from Kavan's mom -- he's an older child, but it should be

even easier to get back on track with a younger baby:

http://health.groups.yahoo.com/group/nosurgery4clubfoot/message/20921

Has Sophia still been wearing the shoes 14-16 hrs or so? Have her

feet been slipping?