Achilles tenotomy as part of the Ponseti method is a minor procedure to release the tight Achilles tendon in a baby being treated for clubfoot (congenital talipes equinovarus). It completes the correction achieved by serial casting.
After serial casting has corrected most of the deformity, the Achilles tendon is divided through a tiny incision or percutaneously (through the skin with a blade) under local anaesthetic. The foot is placed in a final cast for three weeks while the tendon heals at its new, longer length. The procedure takes five to ten minutes.
Approximately 80-90% of babies treated with the Ponseti casting method require an Achilles tenotomy to correct the residual equinus (downward pointing) of the foot.
Continued casting alone may correct mild equinus, but most clubfeet require tenotomy to achieve full correction.
Performed as a day-case procedure, often in clinic. The baby has usually had four to six weekly casts before the tenotomy.
Complete correction of the equinus component of the clubfoot. The tendon heals within three weeks and is stronger at its new length. Success rates with the Ponseti method exceed 95%.
Minor bleeding from the tenotomy site.
Rarely, the equinus may not be fully corrected.
Very rare damage to the peroneal artery.
Very rare with proper technique.
Approximately 20-30% of clubfeet recur and may need repeat tenotomy or tibialis anterior transfer.
Local anaesthetic with sucrose for comfort. Occasionally performed under brief general anaesthesia.
Final cast for three weeks. Then transition to a foot abduction brace (boots and bar), worn full-time for three months, then during sleep until age four to five years. Brace compliance is critical to prevent recurrence.
Cast change at three weeks. Regular follow-up throughout childhood to monitor for recurrence.
Yes, the foot abduction brace is essential to prevent recurrence. It is worn full-time initially, then during sleep until age four to five. Compliance is the single most important factor in preventing recurrence.
Yes, the tendon regenerates and heals at its new, corrected length within three weeks. Studies show the regenerated tendon is structurally normal.