Heel Tenotomy: A Comprehensive Overview for Nursing Students
Introduction
Heel tenotomy is a minimally invasive procedure often used as part of the Ponseti method to correct congenital clubfoot deformity. The procedure involves a percutaneous release of the Achilles tendon to allow for improved foot positioning and function, particularly in infants with a tight or shortened tendon. Nursing professionals play a key role in ensuring patient safety before, during, and after the procedure by providing comprehensive care and education .
Procedure Overview
Heel tenotomy typically involves the following steps:
• Patient Preparation: The infant is carefully assessed and prepped under strict aseptic conditions. Local anesthesia, sometimes accompanied by sedation, is administered.
• Identification of Landmarks: The surgeon uses anatomical landmarks to locate the Achilles tendon.
• Percutaneous Release: A small incision is made to release the tendon, allowing for correction of the foot’s equinus deformity.
• Post-procedure Casting: A cast is applied immediately after the procedure to maintain the corrected foot position during the healing phase .
Nursing Care Considerations
Pre-procedure
• Assessment & Education:
Nurses perform a thorough history and physical exam, explaining the procedure, its benefits, and possible risks to the caregivers. This step is critical for gaining informed consent and ensuring that parents understand the expected outcomes and necessary post-procedure care measures .
• Preparation:
Ensuring that all equipment is ready, verifying the consent forms, and following fasting guidelines (if applicable) are essential nursing responsibilities.
Intra-procedure
• Maintaining Sterility:
Nurses assist in maintaining a sterile environment and managing the necessary instruments.
• Patient Monitoring:
Continuous monitoring of vital signs and the infant’s comfort level is crucial. Effective communication with the surgical team ensures that any adverse reactions are promptly managed .
Post-procedure
• Observation:
After the procedure, nurses closely monitor the surgical site for signs of bleeding or infection. The integrity of the applied cast is also assessed regularly.
• Education & Discharge Planning:
Nurses educate caregivers about proper cast care, including keeping the cast dry and recognizing early signs of complications. Follow-up appointments are scheduled to track the healing process and evaluate the need for further interventions .
Potential Complications and Their Management
While heel tenotomy is generally safe, several complications may occur:
• Infection: Redness, swelling, or discharge at the incision site requires prompt intervention.
• Bleeding/Hematoma: Excessive bleeding can occur and should be monitored closely.
• Inadequate Correction: Either over- or under-correction of the foot deformity may result, potentially requiring additional intervention.
• Cast-related Issues: Skin irritation or breakdown due to cast pressure may develop.
Nurses must be vigilant in early detection and management of these complications, ensuring timely communication with the surgical team for appropriate interventions .
Nursing Student Learning Points
Heel tenotomy offers several valuable learning opportunities for nursing students:
• Interdisciplinary Collaboration:
Understanding the roles of various healthcare professionals in pediatric orthopedic procedures.
• Patient & Family Education:
Developing effective communication skills to educate caregivers about the procedure and aftercare.
• Clinical Monitoring:
Enhancing skills in recognizing early signs of complications and the importance of maintaining patient safety throughout the perioperative period.
• Integration of Theory and Practice:
Applying classroom knowledge to a clinical setting, reinforcing the importance of evidence-based practice in achieving positive patient outcomes .
Conclusion
Heel tenotomy is a key intervention in the management of congenital clubfoot, significantly improving the functional outcome in affected infants. For nursing students, mastering the associated pre-, intra-, and post-procedural care is essential for providing high-quality, patient-centered care. Through careful monitoring, effective communication, and diligent education, nurses play an integral role in ensuring the safety and well-being of patients undergoing this procedure .