Despite the 4-6 weeks of Ponseti treatment, most cases present with short Achilles tendon. I perform tenotomy in clubfoot patients when they have short heel cords. Since short heel cord pulls the calcaneus upward direction, calcaneus stays in plantar flexion position. As a result the posterior part migrates upward. When we palpate the heel, we can easily notice the softness of the heel as it is empty.
When I decide that the Achilles is short, I plan to do Percutaneous Tenotomy procedure in the Operating Room. Because I want to perform the procedure in a sterile environment while baby doesn’t feel any pain. I prefer to tenotomize the heel cord percutaneously with only 0,5-1 cm length incision.
I apply an above knee cast with the foot externally rotated position.