The efficacy of percutaneous Achilles tenotomy alone (AT) was compared to combined posterior capsulotomy of the ankle joint together with open Achilles tenotomy (PC+AT) in 167 children with 260 clubfeet as a method to correct equinus after Ponseti serial casts. 189 idiopathic, and 71 non-idiopathic clubfeet were reviewed (20 with spina bifida, 12 with Arthrogryposis) with a minimum follow-up of two years (Mean 4.8±2.4 years). 73 idiopathic and 12 non-idiopathic clubfeet underwent AT, while 116 idiopathic and 59 non-idiopathic clubfeet underwent PC+AT. Mean age at surgery was 4.5±4.5 months. Mean dorsiflexion improved from -32.5º to 24.3º postoperatively and to 11.7º at the latest follow up in both groups (p<0.001). Immediate postoperative improvement was significantly higher in the non-idiopathic group than the idiopathic (p<0.005), but this was not sustained until latest follow up (p=0.405). Recurrence rate was significantly higher in non-idiopathic clubfeet (62%) than idiopathic clubfeet (37%), p<0.005, regardless of type of surgery. There was no difference in the mean dorsiflexion range (p=0.333) at final follow-up or recurrence rate (p=0.545) between PC+AT and AT groups in idiopathic and non-idiopathic clubfeet. It might therefore be advisable to perform percutaneous Achilles tenotomy alone without the need for posterior capsulotomy of the ankle joint for equinus 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, more extensive surgery with capsulotomy did not lead to excessive scarring or reduced ankle dorsiflexion compared to percutaneous Achilles tenotomy alone.