Tenotomy (Achilles tendon release) is performed in the final stages (and occasionally in earlier stages) of the treatment for clubfoot according to the Ponseti method.
Tenotomy involves cutting the Achilles tendon by puncturing and creating a complete tear, allowing it to elongate and improve the foot's position. The procedure entails a very small incision in the skin, approximately 3-4 mm in size. It is a limited and superficial operation (for comparison, it is smaller than a Hebrew letter) and is less sensitive to pain compared to other parts of the foot. The cut is not sutured but covered and secured with an additional cast that remains in place for three weeks, during which time the gap is filled with scar tissue.
The operation is carried out under sterile conditions in a specialized room for minor surgical procedures. After the procedure, the baby will be observed in the recovery unit for about an hour. If any issue is observed, it may be decided to keep the baby under observation as an inpatient at the hospital.
We make efforts to minimize pain, but we try to avoid general anesthesia during the procedure. Therefore, we use local anesthesia with a cream applied to the skin, along with local injection anesthesia. Additionally, we provide pain relief through oral medication or suppository.
Although the procedure is limited and superficial, it may still cause swelling, and like any surgical procedure, there is a risk of infection. Therefore, we perform the procedure under sterile conditions and ensure there is no bleeding before applying the cast. The appearance of a red spot on the cast, a few hours to a few days after the procedure, is common and expected as the cast absorbs the blood from the wound dressing. However, we emphasize that the appearance of fever, prolonged crying, or pressure signs on the cast requires immediate reporting to the doctor. If your child's pediatrician is not available, please contact Shaare Zedek Medical Center at 02-6555111 and ask to be connected to one of the pediatric orthopedic doctors.
You should be prepared for a day's hospitalization covered by your health insurance fund. When you arrive at the clinic, you will go through a formal process of opening the medical file while simultaneously being asked to apply the anesthetic cream and feed your child. The visit to the clinic will last about three hours. The process of discharge after the procedure and the post-procedure observation are standard and do not require specific instructions. At the end of the observation, you will receive a summary letter as required.
Typically, parents are asked to purchase a device after the tenotomy, which will maintain the achieved correction and prevent a recurrence of the deformity. There are various new and used devices available for purchase or loan. Health funds may sometimes reimburse the cost of the purchase, but the arrangements vary, and it is recommended to check with your health insurance fund. Consult with us after the surgery about how to acquire the device.
In summary, it is a short, straightforward, and low-risk procedure. Nevertheless, it should be performed with caution, and parents should be alert to any sign of a problem in their baby's foot after the procedure. This explanation is general and does not replace personalized instructions from the treating physician. The explanations provided here are formulated in the masculine gender for convenience only and are accurate for both genders.
For any questions, you can contact Dr. Ehud Lebel via email at lebel@szmc.org.il.