Surgery: Clubfoot
Percutaneous Achilles tenotomy for clubfoot: procedure, postoperative course and bracing protocol. Dr. Priano, Milan.
Ponseti method with possible percutaneous tenotomy
Learn about this condition →Surgical Techniques
Percutaneous Achilles Tenotomy
Small minimally invasive procedure performed at the end of serial casting (Ponseti method) to complete correction of residual equinus.
Indication
Almost always necessary in Ponseti treatment of clubfoot (approximately 80-90% of cases).
Recovery
Final cast for 3 weeks after tenotomy. Then Dennis-Brown brace for 4 years per protocol.
Extensive Surgical Release
More invasive procedure with release of posterior and medial soft tissues to correct resistant deformities or relapses.
Indication
Severe relapses, atypical forms resistant to Ponseti method, syndromic clubfoot.
Recovery
Postoperative immobilization for 6-8 weeks. Long-term night bracing. Intensive physical therapy.
Postoperative Overview
Clubfoot requires very prolonged follow-up. Adherence to bracing protocol is essential to prevent relapses. Check-ups continue until end of growth.
Detailed Recovery Timeline
Note: The timeline below is a general baseline. The actual postoperative course varies depending on the specific surgical technique chosen (see procedures above).
For percutaneous tenotomy: outpatient procedure (30 minutes), no hospitalization required. For extensive release: 1-2 days hospitalization.
After tenotomy: final cast for 3 weeks. The tendon regenerates completely during this phase. Then start FAB (Foot Abduction Brace).
Months 1-3: FAB brace 23 hours/day. Monthly visits to verify correction maintenance and brace fit.
After 3 months: If correction stable, transition to nighttime brace only (12-14 hours) and during naps.
Return to Sport
Nighttime brace should be maintained until age 4-5 years. Then normal life. No sport limitations once brace is discontinued.
Follow-up Schedule
Monthly follow-ups in first months, then every 3-4 months first year, then biannual until age 4-5, then annual until end of growth.
Possible Complications
Relapses (10-30%): more frequent with poor brace compliance. Residual stiffness. Muscle weakness. Most relapses are manageable with conservative treatment or tibialis anterior transfer.
Clubfoot: condition information page
Causes, diagnosis, conservative options and when surgery is considered.
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