• 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.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.