Indications
- Cavus, Adductus and Varus are fully corrected but ankle dorsiflexion remains <10 degrees above neutral
- Adequate abduction:
- Best sign: Ability to palpate anterior process of the calcaneus as it abducts out from beneath the talus
- Abduction of approximately 60 degrees
- Neutral or slight valgus of os calcis
Technique
1. Anesthesia: General anesthesia or Local anesthesia
2. Skin preparation: Prepare the foot thoroughly from midcalf to midfoot with antispetic
3. Position: Assistant holds the foot in maximum dorsiflexion with knee extended
4. Site of tenotomy: about 1.5-2 cm above the calcaneus
5. Equipment for tenotomy:
- Blade: Size #11 or #15 or other smaller blades OR
- Needle: 18 G (<6 months age); 16 G (>6 months age)
6. Tenotomy:
- Blade tenotomy:
- Insert the tip of the scalpel blade from the medial side, directed immediately anterior to the taut tendon keeping the flat part of blade parallel to the tendon
- The blade is then rotated, so that its sharp edge is directed posteriorly towards the tendon. The blade is then moved a little posteriorly.
- Needle tenotomy:
- Cut the tendon with the tip of needle from medial to lateral (grating sensation is felt as the fibers are cut)
- Signs of completed tenotomy:
- A “pop” is felt as the sharp edge releases the tendon
- Additional 15 to 20 degrees of dorsiflexion is typically gained after the tenotomy
- Negative Thompson test
7. Post-tenotomy cast:
- Type: Above knee cast
- Position: 60-70 degrees abduction of foot and 15 degrees dorsiflexion
- Duration: 3 weeks
References:
- Clubfoot: Ponseti Management (3rd Edition)
- Percutaneous Achilles Tenotomy with a Large Gauge Needle in Ponseti Management of CTEV: A Modified Technique
![dr. sulabh kumar shrestha](https://epomedicine.com/wp-content/uploads/2020/07/profile.jpg)
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music.