Purpose: To compare efficacy of percutaneous Achilles tenotomy alone to combined posterior capsulotomy of the ankle joint together with open Achilles tenotomy. Patients & Methods: We retrospectively reviewed 167 patients with 260 congenital clubfeet operated upon for equinus after Ponseti serial casts between the ages of 1 day and 1 year (idiopathic clubfeet) and between 1 day and 10 years (non-idiopathic clubfeet), who presented to our institution between January1, 2001 and January 1, 2011, with a minimum of two years follow-up. Recurrence was defined as failure to passively dorsiflex the ankle beyond 0º. Patients had undergone one of two procedures: either percutaneous Achilles tenotomy (AT) alone, or combined posterior capsulotomy of the ankle joint together with open Achilles tenotomy (PC+AT). 73 idiopathic and 12 non-idiopathic clubfeet underwent AT, while 116 idiopathic and 59 non-idiopathic clubfeet underwent PC+AT. Results: 260 clubfeet met our inclusiion criteria and were followed for a mean period of 4.8±2.4 years. 189 clubfeet (72.7%) were idiopathic, and 71 (27.3%) were non-idiopathic (20 associated with spina bifida, 12 with Arthrogryposis, 2 with congenital myopathy & 38 with other chromosomal and developmental abnormalities). Mean age at surgery was 3.4±1.2 months (idiopathic clubfeet) and 7.3±7.8 months (non-idiopathic), p<0.005. The overall mean dorsiflexion range improved from -32.5º to24.3º immediately postoperatively and to 11.7º at the latest follow up of 4.8±2.4 years (5±2.5 years for the idiopathic clubfeet and 4.3±2.1 years for the non-idiopathic clubfeet), which was found to be highly statistically significant for both groups (p<0.001). Immediate postoperative improvement was significantly higher in the non-idiopathic group than the idiopathic (p<0.005), but the difference in improvement between the two groups was statistically insignificant at latest follow up (p=0.405). The improvement in dorsiflexion was significantly higher for PC+AT than AT at latest follow up in both idiopathic (p=0.008) and non-idiopathic (p=0.008), but with no difference in the mean dorsiflexion range at latest follow-up (p=0.333) between the AT and the PC+AT groups. Recurrence rate was significantly higher in the non-idiopathic clubfeet (62%) compared to the idiopathic clubfeet (37%) with p<0.005 regardless of the type of surgery. 29.1% of idiopathic clubfeet recurred after AT and 32.6% recurred after PC+AT (p=0.646). 78.6% of non-idiopathic clubfeet recurred after AT, and 61.3% recurred after PC+AT (p=0.355). Conclusion: The addition of a posterior capsulotomy to Achilles tenotomy neither improved the mean dorsiflexion range at the latest follow nor did it decrease the rate of recurrence of equinus or the need for further treatment even in the non-idiopathic clubfeet. It might therefore be advisable to perform percutaneous Achilles tenotomy alone instead of a bigger procedure involving posterior capsulotomy of the ankle for the management of equinus after serial Ponseti casts in idiopathic as well as non-idiopathic clubfeet. It is also worth mentioning, that in this follow up period of 4.8±2.4 years, open surgery with capsulotomy did not lead to excessive scarring or reduced ankle dorsiflexion compared to percutaneous Achilles tenotomy alone.