What is Percutaneous Achilles Tenotomy?
Percutaneous Achilles tenotomy is a minimally invasive procedure used primarily to treat equinus deformity (limited upward movement of the foot at the ankle) in infants with congenital clubfoot and sometimes in adults with tight or contracted Achilles tendons that do not respond to conservative treatment. The procedure involves making a small incision through the skin (percutaneous) to cut the tight Achilles tendon that is limiting normal foot movement.
Anatomy
Tendons are the soft tissues connecting muscle to bone. The Achilles tendon is the longest tendon in the body and is present behind the ankle, joining the calf muscles with the heel bone. Contraction of the calf muscles tightens the Achilles tendon and pulls the heel, enabling the foot and toe movements necessary for walking, running, and jumping.
Indications for Percutaneous Achilles Tenotomy
Percutaneous Achilles tenotomy is commonly indicated to:
- Clubfoot correction (especially in infants during the Ponseti method)
- Chronic Achilles tendon contracture
- Equinus deformity (as part of cerebral palsy or neuromuscular conditions)
- Tendon tightness leading to gait abnormalities
Procedure for Percutaneous Achilles Tenotomy
The procedure for percutaneous Achilles tenotomy is quick, minimally invasive, and typically performed under local anesthesia. It involves releasing the tight Achilles tendon to improve foot positioning, particularly in cases like clubfoot. In general, the procedure involves the following steps:
- The patient lies on their stomach or back with the foot accessible.
- The back of the ankle (Achilles tendon area) is cleaned with antiseptic solution.
- The surgeon palpates (feels) the Achilles tendon to identify the tightest point, usually about 1–2 cm above where it inserts into the heel (calcaneus).
- A small stab incision (2–3 mm) is made in the skin, typically on the medial (inner) side of the tendon.
- A scalpel blade or tenotome is inserted through this small puncture to reach the tendon.
- The surgeon gently slices the tendon, not all the way through at once but enough to release the tension and allow the foot to dorsiflex (bend upward).
- The surgeon gently dorsiflexes the foot to ensure full correction is achieved.
- The incision is closed, and a sterile bandage is applied.
Postoperative Care
Following the procedure, a long leg cast (infants) or short walking boot (adults) is applied immediately to hold the foot in the corrected position. The cast is typically worn for about three weeks to allow the tendon to heal in its lengthened position. Once the cast is removed, in cases of clubfoot, a foot abduction brace is used to prevent recurrence, worn full-time initially and then during naps and nighttime until around four to five years of age. For older children or adults, the walking boot stays on for 2–6 weeks, depending on the degree of release and healing. This is followed by physical therapy to restore strength, flexibility, and normal gait. Regular follow-up is essential to monitor healing and ensure the foot maintains proper alignment.
Risks and Complications
Although generally safe and effective, percutaneous Achilles tenotomy carries some potential risks:
- Incomplete tendon release
- Overcorrection
- Injury to nearby structures
- Bleeding or hematoma around the incision site
- Infection
- Delayed healing or scarring
- Recurrence of deformity, especially if bracing or casting is not followed properly
