Tenotomy

The Achilles tendon, located in the back of the heel, is short and tight in a clubfoot and is resistant to stretching. As a result, the vast majority of children require the release of this tendon with a procedure called a percutaneous tenotomy (cutting of the tendon through the skin). This is the final step in the correction process. Most describe this procedure as a poke to the back of the heel, and it takes no more than 10 minutes to complete. The doctor will use a thin scalpel to cut the Achilles tendon. Following the tenotomy, there is little (1 cm) to no scar and stitches are not required. For most children, the current method of clubfoot treatment does not require them to have surgery beyond a tenotomy. Your child will most likely come home right after this procedure.

 

Local Anesthesia: usually done in the doctor’s office while the child is awake and with either a numbing cream or a shot of pain relief.  Discuss oral pain relief when you go home with your doc. Bring the same items you would to a regular casting visit. 

 

General Anesthesia:  your doctor/hospital will provide you with information regarding this process.  Discuss with your doctor/hospital about a pre-op feeding recommendations and post-op pain relief. Typically, a breasted baby can eat up to 4 hours prior to surgery time. Ask for the earliest scheduled time for surgery. Bring the same items you would to a regular casting visit. You can ask the anesthesiologist/doctor what type of anesthesia they will use (gas or needle),

 

*Ask your doctor for the best way to contact them should you have concerns when you go home from the tenotomy procedure.

 

*A “Z-Lengthening Achilles Tenotomy” is more invasive, not advised and not widely used.

Post-Tenotomy Cast:

The tendon reattaches at proper length in a few weeks while the child is in the post-tenotomy cast.  The post-tenotomy cast is applied after and there may be a small amount of bleeding that gets absorbed by the cast. The stain could be a quarter size or larger.  This cast stays on from anywhere from 2-4 weeks, with 3 weeks being the most common timeframe. When this cast is removed, you can expect an overcorrected foot; this reis normal and the child should go into the brace stage (boots and bars) immediately to maintain correction. The desired result is 10-20 degrees of dorsiflexion (foot pointing up and 60-70 degrees of abduction (foot pointing out).

 *References:  www.mdorthopaedics, www.ponseti.info, clubfoot families, medical practitioners, and the book The Parents’ Guide to Clubfoot by Betsy Miller. *  

*Disclaimer*

The information compiled is from clubfoot family experiences, and the medical community. Doctors and those in the medical field have opinions that may differ. This document is not a substitute for professional medical advice. Consult your doctor with questions. Every clubfoot situation and every clubfoot child's treatment plan may differ slightly.

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