As you mention, the only way to implement this using tail recursion is to switch to using an explicit stack. One possible approach is to convert the tree structure into a stack structure that is essentially a Reverse Polish notation representation of the tree (using a loop and an intermediate stack to accomplish this). You would then use another loop to traverse the stack and build up your result.
Here's a sample program that I wrote to accomplish this, using the Java code at postorder using tail recursion as an inspiration.
(def op-map {'+ +, '- -, '* *, '/ /})
;; Convert the tree to a linear, postfix notation stack
(defn build-traversal [tree]
(loop [stack [tree] traversal []]
(if (empty? stack)
traversal
(let [e (peek stack)
s (pop stack)]
(if (seq? e)
(recur (into s (rest e))
(conj traversal {:op (first e) :count (count (rest e))}))
(recur s (conj traversal {:arg e})))))))
;; Pop the last n items off the stack, returning a vector with the remaining
;; stack and a list of the last n items in the order they were added to
;; the stack
(defn pop-n [stack n]
(loop [i n s stack t '()]
(if (= i 0)
[s t]
(recur (dec i) (pop s) (conj t (peek s))))))
;; Evaluate the operations in a depth-first manner, using a temporary stack
;; to hold intermediate results.
(defn eval-traversal [traversal]
(loop [op-stack traversal arg-stack []]
(if (empty? op-stack)
(peek arg-stack)
(let [o (peek op-stack)
s (pop op-stack)]
(if-let [a (:arg o)]
(recur s (conj arg-stack a))
(let [[args op-args] (pop-n arg-stack (:count o))]
(recur s (conj args (apply (op-map (:op o)) op-args)))))))))
(defn eval-tree [tree] (-> tree build-traversal eval-traversal))
You can call it as such:
user> (def t '(* (+ 1 2) (- 4 1 2) (/ 6 3)))
#'user/t
user> (eval-tree t)
6
I leave it as an exercise to the reader to convert this to work with a Antlr AST structure ;)