Congenital Talipes Equino Varus – Ponseti Tenotomy – Leaflet 3

Patient Experience

  • Reference Number: HEY1476-2025
  • Departments: Paediatrics
  • Last Updated: 31 July 2025

The Tenotomy

Once your baby’s Pirani score has reduced and we are able to stretch the foot outwards, they will then require a release of the tight tendon at the back of the heel. This allows the foot to achieve a weight-bearing position.  This procedure is carried out by a Paediatric Orthopaedic Consultant in the Ponseti clinic.

The consultant will explain the procedure and then ask you to sign a consent form.

Local anaesthetic cream will be applied to the baby’s heel and left in place for at least 30 minutes.  The Achilles tendon is then released allowing the hind foot to move more freely.  Parents will be asked to wait outside the room whilst the procedure takes place which is usually only 10 to 15 minutes. There will be a small plaster and possibly steristrips applied to the wound.

Your baby’s foot will then be put back into Plaster of Paris (POP) for a further 2 weeks with the foot now pointing outwards and upwards to allow the tendon to heal in a lengthened position.

Following the Tenotomy, most babies settle very quickly but occasionally your child may be a little unsettled but this will soon pass.  You may wish to ask your GP if you are able to give your child Calpol following this procedure depending on their age.

Occasionally you may find slight bleeding on the cast following this procedure. This is quite usual, but if it continues to grow in size (bigger than a 50p), please contact the Ponseti team or attend A&E outside normal working hours with this leaflet.

Two weeks later the POP is then removed in the usual way following a bath at home.

If you need to attend the Accident and Emergency Department

If you were given this leaflet after this procedure, there will be a sheet attached as below for you to take to A&E:

INFORMATION FOR THE CASUALTY OFFICER:

 Re: ……………………………………………………………………

This child has undergone a Tenotomy of the ­­­­___________________ Achilles tendon on   _______­­­­______ by ______________________________ Paediatric Orthopaedic Consultant.   This was performed under a local anaesthetic and the bleeding stopped prior to the POP being applied.

Occasionally slight bleeding may appear on the outside of the cast which is normal.

If they attend A&E outside normal working hours and you feel the cast has to be removed, please be aware that there is minimal padding and remove with scissors if possible.

The cast must be replaced as soon as possible (but only by the Ponseti team); therefore parents need to contact the Ponseti team the following day from 08:00 hours.

Yours faithfully

 

Children’s Ponseti Team

If you have any problems, please contact the Children’s Physiotherapy & Occupational Therapy Department on tel: 01482 674532 or tel: 01482 674539.

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