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Introduction The Ponseti method is the first choice for congenital clubfoot with the possibilities of transverse tenotomy being underexplored in repair of the Achilles tendon in pediatric patients. The objective was to identify specific features of the Achilles tendon repair after experimental transverse intersection and preserved peritenon, vessels and nerves of growing rabbits. Material and methods The experimental study included 20 Chinchilla rabbits of both sexes aged 1.0–1.5 months used as a biomodel with a weight of 1476.0 ± 114.3 g. Rabbits were sacrificed in groups of five by air embolism under local anesthesia at 15, 30, 60 and 90 days of surgery. Results The tendon defect zone was represented by small areas of dense fibrous scar tissue with some cellular fibroblasts, and tendon fibers of unremarkable architectonics arranged in a mutually parallel waves could be seen in the layers of connective tissue at 90 days. The thickness of the first-order collagen fibers increased to 8.9 ± 1.32 μm and comparison with the normal value of 9.2 ± 1.88 μm showed no statistically significant difference (p = 0.38). The thickness of the second-order collagen fibers increased to 28.1 ± 1.28 μm during the time, and comparison with the standard measurements of 28.3 ± 2.23 μm demonstrated no statistically significant difference (p = 0.64). Discussion According to the literature, the ability of the tenoblast to synthesize structural proteins and regulatory biomolecules after injury decreases with age and leads to fibrous restoration of the tendon and formation of a permanent scar. Our study on growing rabbits showed that the organotypic structure of the experimental tendon restored at the intersection site at 60 days with the Achilles tendon defect being represented by the tendon-like tissue at 90 days. Conclusion The Achilles tendon was shown to regenerate in optimal conditions after the dissection and preservation of the peritenon, vessels and nerves with tendon tissue being formed within a short time (3 months after the intervention) being identical to the original.

Background: Clubfoot management according to the Ponseti method, including 4–5 years of bilateral foot abduction bracing to prevent relapse, is widely accepted as gold standard. Adherence to bracing is often low, despite non-adherence being associated with poor outcomes. Objectives: This systematic scoping review aimed to identify and synthesize factors associated with brace adherence and non-adherence in the Ponseti method, to identify strategies shown to improve adherence, and to provide a clinically meaningful synthesis of available evidence. Methods: This scoping review utilized systematic search and formal guidance on conduct and reporting. Medline, SCOPUS, Informit, EmCare, CINAHL, and PEDro databases were searched for peer-reviewed primary research reporting factors associated with brace adherence or non-adherence during Ponseti management. Factors were identified, then grouped using inductive then deductive methods and reported in a narrative synthesis. Results: A total of 413 studies were identified and 42 were included in the review: 31 quantitative and 11 qualitative, generally of low quality. Meta-analysis was not feasible. Factors associated with non-adherence were identified more often than with adherence, and findings for both were inconsistent. Fifty-three factors were investigated, with conflicting findings common. No studies evaluating strategies to improve brace adherence were identified. Conclusions: Available evidence does not indicate that any one factor or set of factors is consistently associated with adherence or non-adherence to bracing in Ponseti clubfoot management, and so clinically meaningful factors are proposed. Adequately powered longitudinal studies of adherence to bracing are required. Mixed methods approaches would help to inform and evaluate strategies to improve adherence, particularly those routinely recommended in clinical practice. [ABSTRACT FROM AUTHOR]

Case: Traumatic pediatric Achilles ruptures are rare, and few cases have been reported among patients with a history of Achilles tenotomy. A 17-year-old boy with a history of Achilles tenotomies for congenital clubfoot as an infant presented with acute midsubstance Achilles tendon rupture of the right leg. The gastrocnemius fascia was dissected to allow for approximation of the ruptured Achilles tendon segments. Furthermore, the plantaris tendon was harvested and sutured around the Achilles tendon-rupture site to improve strength. Conclusions: Patients with a history of clubfoot and chronic Achilles tendon pain should be alerted to the risk of Achilles tendon rupture. [ABSTRACT FROM AUTHOR]

Congenital clubfoot is a common deformity that affects 1 in 1000 newborns and is frequently detected prenatally during routine prenatal care. A wide variety of detection methods and testing are used to identify clubfoot and other congenital anomalies in the fetus, including complete ultrasonography, amniocentesis, chorionic villus sampling, or cell-free DNA. Newer studies have associated certain genome sequences to clubfoot specifically. It is important for orthopaedic surgeons to understand the implications of the various tests to provide the appropriate prenatal counseling. Early prenatal detection of clubfoot can help parents prepare for the demands of caring for a child with clubfoot and build trust between families and clinicians, ultimately leading to better, patient-centered care for their children. Key Concepts: (1) Prompt recognition and treatment of congenital clubfoot is imperative to facilitate optimal treatment. (2) Prenatal diagnosis usually consists of sonography of the plantar surface of both feet at 13–16 weeks' gestation. (3) Additional post-natal testing may be indicated in patients with neurological impairment or syndromic features. (4) Genetic markers such as PITX1, RBM10, HOX, and CASP (among others) have been identified as involved in clubfoot development and have implications on prenatal testing and counseling.

Purpose: The aims of the study were to document the outcomes of percutaneous Achilles tenotomy (pAT) performed in older children with clubfoot, by assessing the clinical, functional and ultrasonographic evidence of Achilles tendon regeneration. Methods: A retrospective case series of older children with clubfoot treated between August 2011 and July 2020 was studied. Clinical assessment of ankle range of motion and calf strength, functional assessment of triceps surae muscle endurance by single leg heel-rise test, and ultrasonographic assessment of Achilles tendon echotexture and dimensions to assess tendon regeneration were performed. Results: Percutaneous Achilles tenotomy was performed on 31 children (48 clubfeet) at a mean age of 5.24 ± 2.14 years (1–10.2 years). At a mean follow-up of 4.86 ± 1.97 years, all children demonstrated normal calf strength with mean dorsiflexion range of 13.64° (0–25°) and mean plantarflexion range of 37.95° (10–40°). The heel-rise endurance test was completed by 27 children with mean 25.85 heel rises/minute (range 17–30) and mean height of heel rise of 6.29 cm (range 4–10 cm). Normal fibrillar tendinous echotexture with homogenous echogenicity was seen on ultrasonography in 41 feet (85.4%) with mean tendon width of 9.7 mm (3.3–16 mm) and thickness of 5.1 mm (1.8–15 mm), comparable with unaffected feet. Conclusions: Clinical, functional and ultrasonographic parameters unequivocally demonstrate complete regeneration of the Achilles tendon, when pAT is performed in older children with delayed-presenting idiopathic clubfoot treated using Ponseti principles. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous tenotomy of the Achilles tendon is a procedure that is part of the Ponseti method for clubfoot correction. The need to apply general anesthesia or sedation for this procedure is controversial. The objective of this study is to compare the acute stress generated in infants by percutaneous Achilles tenotomy under local anesthesia vs. peripheral line placement. Material and methods: This cross-sectional study compares the discomfort experienced by 85 infants undergoing percutaneous Achilles tenotomy with local anesthesia with that experienced by 39 infants undergoing peripheral line placement. The following parameters were determined: the duration of the procedure, crying time, average crying intensity, and maximum crying intensity. Other data recorded included the infant's age and complications arising during the procedure. Results: The mean ages of these patients were 1.95 and 2.18 months, respectively. The following data were obtained: the mean duration of the procedure for Group A was 8.13 s and for Group B it was 127.43 s; the mean duration of crying for Group A was 84.24 s and for Group B it was 195.82 s; the mean intensity of crying for Group A was 88.99 dB and for Group B it was 100.98 dB; and the maximum crying intensity for Group A was 96.56 dB and for Group B it was 107.76 dB. Conclusions: Percutaneous Achilles tenotomy can be safely performed as an outpatient procedure, under local anesthesia. This method generates less discomfort than peripheral line placement. [ABSTRACT FROM AUTHOR]

Amniotic band syndrome (ABS) and clubfoot are distinct congenital musculoskeletal conditions that can occasionally co-occur, creating unique challenges in their management. This paper summarizes the comprehensive discussion on the management of amniotic band syndrome (ABS) and clubfoot, emphasizing the critical role of the Ponseti method and the challenges faced in treatment, thereby providing a basis for further research and improved patient care. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous tenotomy of the Achilles tendon is a procedure that is part of the Ponseti method for clubfoot correction. The need to apply general anesthesia or sedation for this procedure is controversial. The objective of this study is to compare the acute stress generated in infants by percutaneous Achilles tenotomy under local anesthesia vs. peripheral line placement. Material and methods: This cross-sectional study compares the discomfort experienced by 85 infants undergoing percutaneous Achilles tenotomy with local anesthesia with that experienced by 39 infants undergoing peripheral line placement. The following parameters were determined: the duration of the procedure, crying time, average crying intensity, and maximum crying intensity. Other data recorded included the infant’s age and complications arising during the procedure. Results: The mean ages of these patients were 1.95 and 2.18 months, respectively. The following data were obtained: the mean duration of the procedure for Group A was 8.13 s and for Group B it was 127.43 s; the mean duration of crying for Group A was 84.24 s and for Group B it was 195.82 s; the mean intensity of crying for Group A was 88.99 dB and for Group B it was 100.98 dB; and the maximum crying intensity for Group A was 96.56 dB and for Group B it was 107.76 dB. Conclusions: Percutaneous Achilles tenotomy can be safely performed as an outpatient procedure, under local anesthesia. This method generates less discomfort than peripheral line placement.

Kite and Ponseti methods are two popular manipulating methods for correcting the deformity of idiopathic congenital clubfoot. We aimed to compare the efficacy of Kite and Ponseti methods in the treatment of children with idiopathic congenital clubfoot. A search was launched on Medline/PubMed, Cochrane Central Register of Controlled Trials, the Web of Science, ProQuest, and Scopus without limits, from inception to May 1, 2024. The outcomes included the rates of initial correction and relapse (primary) as well as the number of casts and duration of treatment (secondary). Mean difference (MD) and risk ratio (RR) were calculated for numerical and dichotomous outcomes, respectively, with 95% confidence intervals (CIs). Nine studies were included. Meta-analysis showed the Ponseti method is significantly associated with a higher probability of correction (n = 6, RR = 1.23 [95% CI = 1.14, 1.32], p < 0.001) and a lower risk of relapse (n = 5, RR = 0.50 [95% CI = 0.36, 0.71], p < 0.001) compared to the Kite method. The Ponseti method utilized a lower number of casts (MD = -3.0 [95% CI = -5.8, -0.2], p = 0.04) and took a shorter duration (MD = -39.76 [95% CI = -67.22, -12.30], p = 0.02) than the Kite method. Evidence suggests that the Ponseti method results in better outcomes than the Kite method in terms of successful initial correction and lower relapse rates. However, the available studies showed varying degrees of risk of bias, and the length of follow-up was inadequate in some studies., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Raslan et al.)