Make certain the indications for
equinus correction have been met.
PERCUTANEOUS
HEEL CORD TENOTOMY
Plan to perform the tenotomy in
clinic.
PREPARING THE
FAMILY
Prepare the family by explaining
the procedure. Sometimes a mild sedative may be given
to the infant [A].
EQUIPMENT
Select a tenotomy
blade such as a #11 or #15 or any other small blade
such as an ophthalmic knife.
SKIN PREPARATION
Prep the foot medially, posteriorly,
and laterally [B].
ANESTHESIA
A small amount of local anesthetic
may be in.ltrated near the tendon [C]. Be aware that too
much local anesthetic makes palpation of the tendon dif.cult
and makes the procedure more dangerous.
HEEL CORD TENOTOMY
Perform the tenotomy [D] approximately
1 cm above the calcaneus. Avoid cutting into the cartilage
of the calcaneus. A "pop" is felt as the tendon
is released. An additional 10 to 15 degrees of dorsi.exion
is typically gained after the tenotomy [E].
POST-TENOTOMY
CAST
Apply the .fth cast [F] with the
foot abducted 60 to 70 degrees with respect to the frontal
plane of the tibia. Note the extreme abduction of the
foot with respect to the leg and the overcorrected position
of foot. The foot is never pronated. This cast is left
in place for 3 weeks after complete correction.
CAST REMOVAL
After 3 weeks, the cast is removed.
Note the correction [G]. Thirty degrees of dorsi.exion
is now possible, the foot is well corrected, and the operative
scar is minimal. The foot is ready for bracing.
