Achilles- Tenotomy in the Treatment of Clubfoot: Local Experience and Review of Procedural Considerations

Achilles tenotomy (AT) is part of the Ponseti method for management of clubfoot. It is performed in rates of 80-100% of treated feet. Performance of this limited surgical procedure should be safe, painless, efficacious, and cost-effective. Various techniques and setups were described for this procedure. We hereby describe the experience in a large clubfoot center, and discuss consequences of this practice.

Within 5 years (2012-2016) we managed 134 new cases of clubfoot. Fourteen babies continued clubfoot management elsewhere (14/134, 10%). All babies were managed according to the Ponseti method, 98 (81%) were indicated for AT. The remaining 22 children are carefully followed. The procedure is done in an outpatient clinic office. Pain control includes feeding, rectal Acetaminophen, and injected local anesthetic. Percutaneous AT is performed under sterile conditions and plaster cast is applied. The baby is discharged after 1 hour of recovery (total visit time 2-3 hours). Staff includes a nurse and the performing surgeon. Reimbursement is for “daycare-surgery”. Appreciation of the degree of pain was estimated as minimal and causing very short restlessness. During this period no serious complications or need for hospitalization were noted. Comparing to AT performed in the operating theatre, the hereby described procedure involved shorter duration, no overnight stay, limited staff, and much lower expenses.

AT was described in various surgical techniques; percutaneous is the most common. Types of pain control range from feeding only, to general anesthesia. The protocol described here is aimed to reduce pain and risk for the baby, and to allow efficacious work of the clubfoot clinic in the Israeli medical environment.