Surgery: Clubfoot

Percutaneous Achilles tenotomy for clubfoot: procedure, postoperative course and bracing protocol. Dr. Priano, Milan.

Ponseti method with possible percutaneous tenotomy

Surgical Techniques

Percutaneous Achilles Tenotomy

Small minimally invasive procedure performed at the end of serial casting (Ponseti method) to complete correction of residual equinus.

When it is used

Frequently necessary during Ponseti treatment of clubfoot, in a large proportion of cases. The decision is clinical, based on residual equinus at the end of serial casting.

Recovery

Final cast for a few weeks after tenotomy, then abduction brace according to the protocol, with duration tailored to the individual child.

Extensive Surgical Release

More invasive procedure with release of posterior and medial soft tissues to correct resistant deformities or relapses.

When it is used

Severe relapses, atypical forms resistant to the Ponseti method, syndromic clubfoot.

Recovery

Postoperative immobilization for some weeks. Long-term night bracing. Dedicated rehabilitation.

Postoperative Overview

Clubfoot requires prolonged follow-up. Adherence to the bracing protocol is the key factor in reducing the risk of relapse. Check-ups continue until the end of growth. The course described below is an indicative pathway, personalised for each child.

Recovery Pathway (indicative)

Note: This is an indicative pathway, personalised after surgery. Some elements are relatively stable (goal of the procedure, approximate hospital stay, presence of a cast or brace); others depend on the individual case (weight bearing, range of motion, imaging, sport, hardware removal, follow-up intervals) and on the surgical technique chosen.

Hospital stay
Percutaneous tenotomy: a short procedure, usually performed in a day-surgery setting; organisation and anaesthesia are decided case by case. Extensive release: one to two days in hospital.
First weeks
After tenotomy: final cast for a few weeks, during which the tendon heals and restores its continuity. The abduction brace (FAB) is then started.
Second month
Brace worn for most of the day according to the protocol, with regular visits to verify maintenance of correction and brace fit.
Third month
Once correction is stable, transition to night-time and nap-time bracing, with timing decided at follow-up.
Return to sport
Night-time bracing is generally maintained for several years, indicatively up to around 4-5 years of age. Once bracing is discontinued the prognosis is generally favourable, with a personalised follow-up.
Follow-up
Frequent follow-ups in the first months, then progressively spaced out until the end of growth, with intervals tailored to the individual course.

Possible Complications

Relapses: more frequent with poor brace compliance. Residual stiffness. Muscle weakness. Most relapses can be managed with conservative treatment or tibialis anterior transfer.

For parents

Clubfoot: condition information page

Causes, diagnosis, conservative options and when surgery is considered.

Questions about this surgery?

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