Percutaneous Needle Tenotomy for Tendo-achillis Release in Clubfoot- Authors’ Reply

Sir, We appreciate the interest of Patnaik S [1] in our paper published in Journal of Orthoapedic Case Reports [2] and thank him for sharing his experience with the technique. We shall answers the queries raised sequentially. We are routinely using 16 or 18 gauge needle depending on the size of the child and in very young child infant a 18 gauge needle is enough. The trick is to tense the tendon by dorsiflexion and then cutting with the tip of the needle [you can feel the grating. This does not require a strong force if layer by layer cutting using the tip of the needle is done. Do not try to cut the entire tendon in one go. As one does more cases, an idea of force needed and needle that is best suited is developed. We have done this procedure as a part of ponseti technique, thus the indications of age are extension of ponseti and the procedure can be done safely till 6-8 months of age. We are routinely using Pirani scoring [3] for assessment of our cases. The follow up protocol is same as ponseti protocol and as mentioned in the article corrective cast is given for 3 weeks. We again appreciate the interest in our technique and sincerely hope it benefits more surgeons and patients.