Tenotomy FAQ

The majority of tenotomies are done under local anesthetic as recommended. The procedure is short and anesthetic poses its own risks, as well children are more distressed by not eating or drinking prior to anesthetic.

Most children only need one tenotomy, but each child’s situation is different and will have a custom needs assessment and treatment plan prescribed by their healthcare provider.

The decision to be in the room for the tenotomy should be discussed with your doctor, where you can agree on the best approach for your child and if you feel comfortable watching this little procedure. During the procedure you are there to be a calming support to your child.

Babies will cry during the procedure, mostly because they do not like being restrained, and are easily comforted after the procedure.

You can give your child the recommended dose of pain medication, such as Acetaminophen (Tylenol/Paracetamol) an hour prior to the procedure if they are having local anesthetic.

Watch for bleeding throughout the cast (a small spot of blood at the start is normal, but watch that it doesn’t continue to grow in size), and swelling or purple discolouration of the toes.

Have infant pain medication on hand for after the procedure and be prepared to soothe and comfort your child throughout the day/evening that follows.

Botox is being used in a small number of cases in lieu of a tenotomy. It is not recommended in the Ponseti Method.

All cases are different and not all need a tenotomy. The majority of clubfoot babies require a tenotomy. Your doctor will make a plan with you for your child’s individual case.

You know your baby best; however they typically like to be comforted will also be your best bet after the tenotomy. For the first day or two after the surgery, pain medication can be used as directed on the box. Many babies will want cuddles and extra nursing sessions throughout this period.

If the spot of blood continues to grow past the first day or is leaking through the cast, you must see a doctor immediately. Consider going to emergency to have the cast removed and bleeding stopped. If this is necessary contact your doctor to have the cast reapplied. It should not be reapplied by anyone other than your practitioner.

Ponseti Method recommends that the casts are worn for three weeks after the tenotomy.

It is a small incision in the heel that cuts the Achilles’ tendon. A tenotomy is necessary to ensure appropriate dorsiflexion in the foot. Most clubfoot babies are born with shorter and tighter Achilles’ tendons, and the tenotomy allows the tendon to be severed and regrown. Sutures are not needed.

There is a small amount of bleeding at the surgical site.

The tenotomy is typically performed the day the final stretching cast is removed. After the tenotomy is performed, the final cast will be placed and will remain on for three weeks to allow the Achilles tendon to completely heal. Your doctor should be able to give you advanced notice that at the next appointment you may have a tenotomy done.

Always remove a slipped cast and contact your doctor immediately. Your child can be recasted. Leaving a slipped cast WILL create further complications. Recasting only adds a bit of time to treatment.