Can you believe this? The doctor who is treating my nephew for clubfoot wants to cut into his leg and cut the Achilles tendon without any anesthesia. I’m telling my sister to find a different doctor but thought I’d check with you to see what you think.

Before you hit the panic button consider this: about 80 per cent of young children who have the standard Ponseti method of treatment (manipulation of the foot and casting) also need a release of the Achilles tendon. Often the forefoot correction is successful with the casting treatment but the hind foot remains rigidly in an equinus and varus position.

Equinus means that the toes are pointed down and the ankle flexed forward (sort of like the position of the foot when a ballet dancer is on her toes). Varus means tilted inward. The ankle is in varus when you try to put the soles of your feet together.

Not all babies or young children with clubfoot treated with the Ponseti Method will need a tenotomy. In many cases, this additional procedure is needed when the abduction brace required after casting isn’t used diligently. It is only during the final stages of the Ponseti manipulation and serial casting, that a tenotomy to release the Achilles tendon (the tendon pulls on the hind foot) is considered. This procedure is most helpful if the hind foot remains uncorrected.

If and when a tenotomy is needed, it is safe to perform the operation as an office procedure. The skin is numbed with a topical agent and the area around the tendon numbed with a local anesthetic. The child does not feel anything more than a sense of pressure (if even that much). It isn’t necessary to put them to sleep. The tendon is released safely and effectively without complications. The foot is put in a cast for three weeks and bracing is continued after the cast comes off.

When the parents follow-up diligently with the home program, the results are excellent. With good parental compliance, the need for a second tenotomy is eliminated. The most helpful thing family members can do is love and support the parents going through this with their child. Your efforts to obtain additional information is very excellent. Encouraging parents to follow-up with any recommendations made by the surgeon (especially use of the special brace) may be the best thing you can do to come alongside them at this time.