In Ponseti management of idiopathic clubfoot, after achieving adequate correction with serial casting, the Achilles tendon tenotomy is performed when dorsiflexion is less than which value in the corrected foot?

• A Less than 0 degrees (plantar flexion only)
• B Less than 15 degrees of dorsiflexion
• C Less than 20 degrees of dorsiflexion
• D Less than 10 degrees of dorsiflexion ✓

Explanation

In Ponseti's method, after correcting the cavus, adductus, and varus with serial casts, the equinus is addressed last. Percutaneous Achilles tendon tenotomy is indicated when dorsiflexion cannot be achieved to at least 10–15 degrees despite adequate correction of the other components. Specifically, tenotomy is performed if dorsiflexion is <10 degrees in a corrected foot — in practice, about 80–90% of idiopathic clubfoot cases require tenotomy at this stage because the Achilles tendon is the last structural barrier. After tenotomy, a final cast for 3 weeks allows the tendon to regenerate.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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