Most CTEV children will need the tenotomy, which is a minor procedure usually done with local anaesthetic. Children need the tenotomy because their heel (Achilles) tendon is short and tight and it pulls the heel up.If it is not corrected the child will walk on tiptoes. Some doctors use general anaesthetic for older patients. After the tenotomy a final POP cast is applied and left on for three weeks. During this time the tendon regenerates in the lengthened position and the foot can be bent up easily towards the front of the leg (dorsiflexion). If your baby is unhappy after the tenotomy, it is fine to use some paracetamol as you would after vaccinations

1. TENDO ACHILLES
TENOTOMY AS A PART OF
PONSETTI TECHNIQUE FOR
CLUB FOOT CORRECTION
Dr Joe Antony

2. Indications
◦ When cavus, adductus, and varus are fully corrected
◦ Ankle dorsiflexion remains less than 10 degrees above neutral
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3. Signs of adequate abduction
◦ Ability to palpate the anterior process of the calcaneus as it abducts out from beneath the talus
◦ Abduction of approximately 60 degrees
◦ Neutral or slight valgus of calcaneum
Best sign
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4. Preparation
◦ Preparing the family Prepare the family by explaining the procedure. Explain that tenotomy is a minor procedure performed under
local anesthetic in the outpatient clinic or minor OT.
◦ Equipment Prepare all of the material in advance
◦ Tenotomy blade, such as a #11 or #15.
◦ Skin preparation Prep the foot thoroughly from midcalf to midfoot with an antiseptic while the assistant holds the foot from the
toes with the fingers of one hand and the thigh with the other.
◦ Anesthesia A small amount of local anesthetic may be infiltrated near the tendon
◦ Be aware that too much local anesthetic makes palpation of the tendon difficult and the procedure more complicated.
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5. Set up
◦ With the assistant holding the foot in maximum
dorsiflexion, select a site about 1.5 cm above the
calcaneus for the tenotomy.
◦ Infiltrate a small amount of local anesthetic just
medial to the tendon at the site selected for the
tenotomy.
◦ Be aware that too much local anesthetic makes
palpation of the tendon difficult and the procedure
more complicated.
◦ Keep in mind the anatomy. The neurovascular
bundle is anteromedial to the heel cord
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6. Tenotomy
◦ Insert the tip of the scalpel blade from the medial side,
directed immediately anterior to the tendon.
◦ Keep the flat part of the blade parallel to the tendon.
◦ The initial entry causes a small longitudinal incision. Care
must be taken to be gentle to avoid accidentally making a
large skin incision.
◦ The blade is then rotated, so that its sharp edge is directed
posteriorly towards the tendon.
◦ The blade is then moved a little posteriorly.
◦ A “pop” is felt as the sharp edge releases the tendon
◦ The tendon is not cut completely unless a “pop” is
appreciated.
◦ An additional 15 to 20 degrees of dorsiflexion is typically
gained after the tenotomy
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7. Post tenotomy cast
◦ After correction of equinus by tenotomy, apply the cast with the foot abducted 60 to 70 degrees with respect to the frontal plane
of the ankle, and 15 degrees dorsiflexion.
◦ The foot looks over-corrected with respect to the thigh.
◦ This cast holds the foot for 3 weeks after complete correction.
◦ It should be replaced if it softens or becomes soiled before 3 weeks.
◦ The baby and mother may go home immediately.
◦ Usually no analgesic is necessary.
◦ This is usually the last cast required in the treatment program
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8. Errors during tenotomy
◦ Premature equinus correction
◦ Incomplete tenotomy
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9. Thank you
Reference
• Global HELP ponsetti
manual
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