If your child has had or is facing clubfoot surgery scars are a natural concern. Whether it's the small mark left by an Achilles tenotomy or more extensive scarring from a posteromedial release, understanding what to expect, how to care for the wound, and what the scars will look like over time can help you feel prepared and less anxious about the visual outcome.
Types of Clubfoot Surgery and Their Scars
Different surgical procedures leave different types of scars. The most common surgeries in clubfoot treatment today, performed within the NHS, are:
Achilles Tenotomy
This is by far the most common surgical procedure in clubfoot treatment and is a standard part of the Ponseti method. Around 80–90% of babies undergoing Ponseti treatment will need a tenotomy — a small cut through the Achilles tendon to allow full dorsiflexion correction.
The scar characteristics:
- Size: Typically 3–5mm — barely larger than a pinprick in many cases
- Location: Back of the ankle, just above the heel
- Technique: Percutaneous (through the skin with a small blade), usually no stitches required
- Healing: The wound is covered by the final plaster cast and heals underneath. By the time the cast comes off (typically 3 weeks later), the skin wound is fully closed
- Long-term appearance: In most children, the tenotomy scar becomes virtually invisible within 1–2 years. It may appear as a tiny white dot or thin line on the back of the ankle
For full details about this procedure, see our Achilles tenotomy guide.
Tibialis Anterior Tendon Transfer (TATT)
This surgery is performed when clubfoot relapses and there's an imbalance favouring inversion (the foot turning inward). It involves moving the tibialis anterior tendon from the inside of the foot to the centre. It's typically done around age 3–5.
The scar characteristics:
- Incisions: Usually two — one on the inner (medial) side of the foot and one on the top (dorsum)
- Size: Each incision is approximately 2–4cm long
- Location: Along natural skin creases where possible, reducing visibility
- Healing: Sutures or skin closure strips are used. The foot is placed in a cast for approximately 6 weeks post-surgery
- Long-term appearance: Scars typically fade to thin pale lines over 12–24 months. They're generally well-hidden by shoe lines
Posteromedial Release (PMR)
This more extensive surgery was the standard treatment for clubfoot before the Ponseti method became widely adopted in the UK from the early 2000s. It's now rarely performed as a primary treatment but may still be needed for complex or resistant cases. Adults who were treated for clubfoot in the 1980s and 1990s often have PMR scars.
The scar characteristics:
- Incision: A single long incision, often in a curved or zigzag pattern, running from the inner ankle around to the back of the heel (Cincinnati incision) or along the inner side of the foot and ankle
- Size: Typically 8–15cm, depending on the extent of the release
- Location: Inner and posterior ankle/foot
- Healing: More complex healing process with higher risk of wound complications
- Long-term appearance: These scars are more prominent and may remain raised, widened, or discoloured for years. Some mature into flat, pale scars; others may become hypertrophic (thick and raised)
Other Procedures
Additional surgeries that may leave scars include:
- Lateral column shortening — an incision along the outer border of the foot
- Calcaneal osteotomy — a cut near the heel bone
- Triple arthrodesis — performed in adults with severe residual deformity, involving larger incisions on the outer foot
What Affects How Scars Heal?
Scar formation is influenced by multiple factors, and two children having the same surgery may end up with quite different-looking scars. Key factors include:
- Age at surgery: Younger skin generally heals with less visible scarring. Tenotomies performed in the first few months of life often produce barely detectable scars
- Skin type and ethnicity: Darker skin tones are more prone to keloid and hypertrophic scarring. This is a genetic tendency that can't be prevented but can be managed
- Wound tension: Scars in areas of high skin tension (over joints, for example) tend to widen more than those in relaxed areas
- Infection: Any wound infection during healing increases the risk of poor scarring. Keeping surgical sites clean and following post-operative instructions is essential
- Nutrition: Adequate protein, vitamin C, and zinc support wound healing. For babies, breast milk or formula provides sufficient nutrition naturally
- Genetics: Some families are predisposed to keloid or hypertrophic scarring regardless of other factors
Scar Care: What You Can Do
After your child's surgery, the orthopaedic team will give specific wound care instructions. General principles for optimising scar healing include:
Immediate Post-Operative Period (0–6 Weeks)
- Leave dressings in place as directed by the surgical team
- Keep the wound dry until advised otherwise (usually until sutures are removed or dissolved)
- Watch for signs of infection: increasing redness, swelling, warmth, oozing, or fever — contact the hospital if any of these occur
- If in a cast, you won't have access to the wound. The cast protects it during this phase
Early Healing Phase (6 Weeks to 3 Months)
- Gentle washing — once the wound is fully closed, you can wash it with mild soap and water during bath time
- Moisturising — applying a simple, fragrance-free moisturiser (such as Diprobase, Cetraben, or plain coconut oil) to the scar 2–3 times daily helps keep the tissue supple
- Scar massage — once the wound is fully healed (no scabs or open areas), gentle circular massage with moisturiser can help break down scar tissue adhesions. Use firm but not painful pressure for 3–5 minutes, twice daily
- Sun protection — new scars are very susceptible to UV damage. Keep the scar covered or apply SPF 50 sunscreen if exposed. UV exposure can cause permanent darkening of the scar
Maturation Phase (3 Months to 2 Years)
Scars continue to remodel for up to 2 years after surgery. During this time:
- Silicone products — silicone sheets (such as Mepiform or Cica-Care) or silicone gel (such as Dermatix or Kelo-cote) are the most evidence-based scar treatment available without prescription. They work by maintaining hydration and providing gentle pressure. Studies show they reduce scar redness, thickness, and itching
- Continue massage — regular scar massage remains beneficial throughout the maturation phase
- Pressure garments — rarely needed for clubfoot scars but may be recommended for larger surgical scars in children prone to hypertrophic scarring
- Monitor for keloid formation — if the scar grows beyond the boundaries of the original wound, becomes very raised, or is painful/itchy, consult your GP or surgeon
Dealing with Prominent Scars
For older children and adults with more visible clubfoot surgery scars (particularly from PMR or extensive reconstructive surgery), several treatment options exist on the NHS and privately:
NHS Treatment Options
- Steroid injections (triamcinolone) — injected directly into hypertrophic or keloid scars to reduce thickness and flatten them. Usually given as a series of injections at 4–6 week intervals. Available on the NHS through dermatology or plastic surgery referral
- Silicone therapy — may be prescribed by your GP on the NHS for significant scarring
- Scar revision surgery — in cases where scarring is causing functional problems (restricting movement, causing pain, or catching on shoes), surgical revision to improve the scar may be offered. This is more commonly considered for adults with old PMR scars
Private Treatment Options
- Laser therapy — pulsed dye laser can reduce redness; fractional CO2 laser can improve texture. Typically requires 3–6 sessions
- Microneedling — stimulates collagen remodelling and can improve scar texture
- Camouflage makeup — specialist medical camouflage (available through the charity Changing Faces and some NHS trusts) can effectively conceal visible scars for special occasions or daily wear
Adults Living with Clubfoot Scars
For adults who were treated for clubfoot as children — particularly those treated before the Ponseti era — surgical scars may carry emotional as well as physical significance. Many adults describe a complex relationship with their scars: they're reminders of effective treatment that allowed them to walk, but they can also be a source of self-consciousness.
Common concerns raised by adults with clubfoot scars include:
- Scars that ache or feel tight in cold weather
- Difficulty finding shoes that don't rub on scar tissue
- Self-consciousness about scars being visible in sandals or while barefoot
- Questions from others about the scars
If scars are causing ongoing discomfort, your GP can refer you to adult orthopaedics or dermatology for assessment. For pain management around scar tissue, options include physiotherapy, massage, and in some cases steroid injections or scar revision.
Talking to Your Child About Their Scars
As children grow, they may notice their scars and ask about them. How you frame this matters. Research in paediatric psychology suggests that children take their emotional cues about their body from their parents. Simple, factual, age-appropriate explanations work best:
- For toddlers: "The doctor fixed your foot when you were a baby. That little mark shows where they helped you."
- For primary school age: "You were born with a foot that needed some help to grow in the right shape. The doctors used casts and a small operation to fix it, and this scar is where they did the work."
- For teenagers: A fuller explanation including the medical terms, what was done, and reassurance that it's a common condition affecting 1 in 1,000 babies
Framing scars as evidence of successful treatment rather than as damage helps children develop a positive relationship with their body. Our emotional support guide covers this and related topics in more depth.
Frequently Asked Questions
Q: Will my baby's tenotomy scar be visible?
A: In most cases, the Achilles tenotomy scar becomes very faint or invisible within 1–2 years. It's a tiny incision (3–5mm) that heals under the protection of the cast. Many parents report being unable to find the scar after a few years. In children with darker skin, the scar may remain slightly lighter in colour than the surrounding skin but is usually very small.
Q: Can silicone sheets be used on babies?
A: Yes, medical silicone sheets are safe for use on infants once the wound is fully healed (no open areas or scabs). Brands like Mepiform produce paediatric-sized sheets. They should be applied for 12–24 hours per day and can be washed and reused. Always supervise young children to ensure sheets don't come off and become a choking hazard.
Q: My child's scar is red and raised — is this normal?
A: It depends on timing. A scar that is pink or red and slightly raised during the first 6–12 months after surgery is going through normal maturation. Most scars settle down over 12–24 months. If the scar is getting thicker, extending beyond the original wound line, or causing pain or itching after the first year, consult your GP as this may indicate hypertrophic or keloid scarring that would benefit from treatment.
Q: Will the scar stretch or change as my child grows?
A: Scars grow with the surrounding tissue as a child develops. A scar from infant surgery may become slightly wider and longer as the ankle and foot grow, but proportionally it remains about the same. This is why Achilles tenotomy scars remain small — the original incision was tiny, and it scales up minimally.
Q: I'm an adult with a large clubfoot surgery scar — can the NHS help?
A: If the scar is causing functional problems (pain, restricted movement, shoe-fitting difficulties), you can request a GP referral to dermatology or plastic surgery for assessment. If the scar is purely cosmetic and not causing physical symptoms, NHS funding for revision is less likely, but it's still worth discussing with your GP. Some NHS trusts offer medical camouflage services free of charge through organisations like Changing Faces.
Q: Does vitamin E oil help scars?
A: Despite its popularity, the evidence for vitamin E oil on scars is mixed at best. Some studies have shown no benefit, and a proportion of people develop contact dermatitis from topical vitamin E. Silicone-based products have much stronger evidence behind them. If you want a natural option, plain coconut oil or shea butter used during massage provides moisturisation without the allergy risk of vitamin E.