Clubfoot – Percutaneous Achilles Tenotomy

What is a percutaneous achilles tenotomy?

A percutaneous achilles tenotomy (often called a perc TAL) is the final step of correction for a club foot and involves correcting the foot equinus (pointing down) position.

When will it happen?

Your surgeon will advise the ideal timing of the perc TAL based on how your baby’s foot/feet respond to ponseti casting. The perc TAL will be required if the foot remains stiff in a pointing down position following the mid foot correction. Most babies with club foot (up to 90%) will require a perc TAL as part of their treatment. 

Where will it happen and what will it involve?

The procedure will take place in the operating theatre as a day procedure. Your baby’s previous cast will be removed and the foot and leg will be cleaned. Your baby will receive local anaesthetic to the back of their ankle to numb the area as well as light sedation throughout the procedure.

The procedure will involve a small incision through the skin over the achilles tendon allowing the ankle to flex up. Steristrips are applied over the incision and a new plaster cast is applied with the foot in an overcorrected and flexed up position.

This cast will remain in place for two weeks. The cast will then be removed in clinic and boots and bar will be fitted by your orthotist. 

It is normal to see a small area of dried blood on the cast over the back of the heel. Look after your baby’s cast and perform circulation checks as you have done for your previous ponseti casts.

Circulation issues in a cast

It is completely normal for the toes to be mildly blue immediately after the cast is applied  and this should settle over an hour or so

Check you baby’s circulation in the foot every hour for the first 6 hours after the application of each new cast, and then 4 times a day. Do this by gently pressing on the toes and watch the return of colour (blood flow). The toe will turn white as you gently press on it and then quickly return to pink as you release if the blood flow is good.  This is called “blanching”.

If your baby’s toes are consistently very white and your baby is uncomfortable, the cast may be too tight. If this occurs you may need to present to your local emergency department or contact us for advice.

Sometimes your baby’s toes may appear pale or become cold. In this situation warm up the toes by covering with a sock and gently elevate the legs on a towel or pillow.