About 90 percent of children who undergo Ponseti method treatment for clubfoot still have an abnormally tight Achilles tendon after the casting process is complete. A pediatric orthopedic surgeon can correct the problem with an outpatient surgical procedure to lengthen the tendon. The surgery is called an Achilles tenotomy. (It’s also sometimes called a percutaneous tenotomy, a tendo-Achilles lengthening tenotomy, or a heel cord lengthening/tenotomy.)
If your child needs an Achilles tenotomy, a surgeon performs the procedure in Gillette’s cast room or an operating room. After surgery, your child goes home that day and wears a cast for three or four weeks. The tendon heals while in that cast.
- We remove your child’s cast and wash your child’s feet.
- About 15 to 30 minutes before surgery, a nurse applies EMLA cream to your child’s Achilles tendon area and covers the cream with a clear dressing. This numbs the skin where the surgery will be performed.
- It’s helpful to hold off on feeding your child while waiting for surgery. That way, we can soothe your child by giving a bottle during the procedure and at other times when you’re not nearby. (Usually, parents and caregivers aren’t in the room during tenotomy surgery.)
- In addition to your child’s bottle, bring other items that might help soothe your child during surgery. Such items might include a pacifier and a familiar blanket. Also bring extra diapers.
- Your child is in the cast room for about 30-45 minutes. Performing the surgery takes only about one minute per foot. The rest of the time in the room is spent preparing the incision site before surgery and applying a cast afterward.
- We inject a local anesthetic (such as novocaine or lidocaine) in your child’s heel. The EMLA cream applied earlier minimizes the pain this injection might cause your child.
- To perform the tenotomy, the doctor uses a small scalpel to cut through the skin behind your child’s ankle. Then the surgeon carefully cuts the Achilles tendon. The tiny incision in your child’s ankle doesn’t require stitches to heal. After the tendon is cut, we apply a cast (or casts) to your child’s leg(s).
- After surgery, there might be a spot of blood or Betadine (a brown cleansing solution) on your child’s cast. This drainage is normal up to a diameter of 1 1/2 inches. Check the heel area of your child’s cast several times per day. If drainage seems more than normal, contact Telehealth Nursing.
- During the first 24 to 48 hours after surgery, keep your child’s foot (or feet) elevated on pillows or a towel to help prevent or reduce swelling at the surgery site.
- Your child might be fussy for the first 24 hours after surgery. Give infant acetaminophen (Tylenol) to help ease any pain or discomfort your child might feel. (Follow directions on the label to make sure you give the correct dose for your child’s weight.)
- For the first 2-3 days after surgery, check circulation several times per day (as you’ve done after each cast change during the Ponseti casting process). Touch your child’s toes; they should turn white and then pinkish in 3-6 seconds. If the toes are discolored, try changing the position of the leg.
When to Call for Help
Contact Telehealth Nursing at 651-229-3890 if you notice:
- Cast problems (These can be very serious, especially if they affect the leg or foot’s movement, sensation or circulation.)
- Your child acting irritable for no apparent reason
- Change in toe color or temperature
- Increased swelling of toes that isn’t relieved by elevating the leg
- Skin irritation or rashes
- Toes that appear to have slipped back into the cast
- The cast seems too tight or too loose (moving up or down)
- Cracks in the cast
- The cast is damp or wet
- A foreign object inside the cast that you can’t remove with your fingers
- Drainage spots on the cast that are more than 1 1/2 inches in diameter
- Foul smelling odor from the cast (Smell your child’s toes occasionally to check for odor.)
- A fever of 101.3 F (38.5 C) or higher.
We’ll make an appointment for you to return to Gillette three weeks after the tenotomy and casting are done. At that appointment, we’ll remove the cast(s) and you’ll meet with your child’s health care provider to discuss the next step of clubfoot treatment: the foot abduction brace.
This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team. If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.