Foot & Ankle Videos: Other
Arthroscopic Synovectomy of the Interphalangeal Joint of the Great Toe
Synovitis of the interphalangeal joint of the great toe can occur in patients with rheumatoid arthritis, seronegative arthritides, or gouty arthritis or after a penetrating injury to the joint. Complete synovectomy of the joint usually requires a lengthy incision and extensive soft-tissue dissection. The purpose of this Technical Note is to describe the surgical details of arthroscopic synovectomy of the hallucal interphalangeal joint, which can reduce the surgical trauma.Peroneus Longus Tendoscopy at the Sole
Different pathologies can occur in the peroneus longus tendon at the sole. Many of them can be dealt with by peroneus longus tendoscopy of the sole. The purpose of this Technical Note is to describe the details of this minimally invasive approach to the peroneus longus tendon of the sole. This has the advantages of better cosmesis, less soft tissue dissection, less postoperative pain, and less peritendinous fibrosis.Naviculocuneiform Arthroscopy
Surgical interventions at the naviculocuneiform joint are not uncommon to deal with various pathologies of the joint and correction of different foot deformities. To minimize the soft tissue dissection, naviculocuneiform arthroscopy has been described. The purpose of this Technical Note is to report the details of this arthroscopic approach.Bone Marrow Aspirate Concentrate and Microfracture Technique for Talar Osteochondral Lesions of the Ankle
Osteochondral lesions of the talus refer to a chondral or subchondral defect of the articular cartilage and potentially the underlying bone. Ankle sprains are an extremely common injury; approximately 27,000 ankle sprains occur per day in America. Fifty percent of these can lead to a cartilage injury to the ankle. There has been a high quoted rate of failure with conservative measures of up to 45% in some series. Surgical options are largely broken down into 2 groups, namely, reparative or regenerative treatments.Treatment of Malunited Calcaneal Fracture With Posttraumatic Subtalar Osteoarthritis Using Lateral Endoscopic Calcaneoplasty With Posterior Arthroscopic Subtalar Arthrodesis
Malunion of calcaneal fractures is a common complication after improper nonoperative treatment. It may develop into posttraumatic subtalar osteoarthritis, lateral calcaneal wall prominence, and severe foot deformities. This Technical Note reports the technical aspects of lateral endoscopic calcaneoplasty with posterior arthroscopic subtalar arthrodesis for the treatment of malunited calcaneal fracture with lateral calcaneal wall prominence and posttraumatic subtalar osteoarthritis. This technique was chosen because it can reduce the risk of wound complication compared with a conventional lateral extensile approach.A Technique for the Reduction of Complications Associated With Anterior Portal Placement During Ankle Arthroscopy Using a Peripheral Vein Illumination Device
Ankle arthroscopy is a minimally invasive technique for ankle joint treatment. However, injury to the intermediate dorsal cutaneous nerve (IDCN) and the medial dorsal cutaneous nerve (MDCN) is a common complication during anterior portal placement. To prevent injuries, methods such as palpating the nerves topographically and marking the nerves by transilluminating the skin with an arthroscope have been proposed. Easier and more definitive methods of identifying the IDCN and MDCN should result in a reduction of complications.Endoscopic Management of Calcaneofibular Impingement and Posterior Ankle Impingement Syndrome Caused by Malunion of Joint Depressed–Type Calcaneal Fracture
Identification of the correct source of symptoms is the key in formulating the correct treatment plan for heel pain after calcaneal malunion. Calcaneofibular and posterior ankle impingements can occur due to malunion of a joint depressed–type calcaneal fracture. The purpose of this Technical Note is to report the technical details of posterior and lateral decompression through the posteromedial and posterolateral portals using posterior ankle endoscopy.Endoscopic Superior Peroneal Retinaculum Reconstruction
Post-traumatic peroneal tendon subluxation or dislocation is most commonly due to injury to the superior peroneal retinaculum. Acute repair of the retinaculum is an option for active athletes who desire quick return of sport activity. In general, conventional open surgeries require extensive exposure of the injured superficial peroneal retinaculum and have potential risks of scar formation, sural nerve injury, limited range of movement, peroneal tendon re-subluxation, and tendon irritation. The purpose of this Technical Note is to describe the details of endoscopic superior peroneal retinaculum reconstruction.Arthroscopic Arthrodesis of the Lesser Ray Tarsometatarsal Joints: 2-Portal Technique
Tarsometatarsal (Lisfranc) destruction of the tarsometatarsal articulation of the lesser rays is most commonly due to midfoot Charcot neuroarthropathy. Tarsometatarsal arthrodesis is indicated when conservative management cannot relieve the symptoms. The purpose of this Technical Note is to describe a minimally invasive approach of arthroscopic arthrodesis of the destructed lesser ray tarsometatarsal joints. The arthroscopic procedure is performed through the lateral and P1-2 Lisfranc portals. It has the advantages of better cosmesis, less wound complication, less bone resection, and more thorough joint debridement.Endoscopic Resection of Peroneal Tubercle
Symptomatic hypertrophy of the peroneal tubercle can result in pain, clicking sensation, and limitation of ambulation. Surgical resection is indicated for symptomatic hypertrophied tubercle that is recalcitrant to conservative treatment. The purpose of this Technical Note is to report the details of tendoscopic resection of the hypertrophied peroneal tubercle. This is performed through zone 2 peroneus longus tendoscopy. Any associated hindfoot deformity and peroneal tendon pathology should also be addressed.Endoscopic Interdigital Neurectomy of the Foot
Morton's neuroma is a compressive neuropathy resulting in perineural fibrosis rather than a neuroma of the plantar digital nerve. Surgical treatment is indicated for patients with a clear diagnosis of Morton's neuroma and no improvement with nonsurgical treatment. The surgical options include isolated intermetatarsal ligament division, isolated interdigital nerve excision, and interdigital nerve excision with intermetatarsal ligament division, with or without submuscular transposition. This can be performed via dorsal or plantar approach.Arthroscopic Excision of Osteoid Osteoma of the Talus
Osteoid osteoma is a benign tumor that can cause significant pain and disability. Excision of the tumor can be accomplished with open surgery or, as advocated in recent years, with computed tomography (CT)-guided radiofrequency ablation. In this article, a unique arthroscopic approach to excise an osteoid osteoma of the talus is presented. This was possible by relying on a clear intra-articular prominent osteophyte, which was used as a landmark to indicate tumor location in accordance with preoperative CT views.Arthroscopic Triple Arthrodesis in Management of Chronic Flatfoot Deformity
Triple arthrodesis has a significant role in the management of hindfoot osteoarthritis and deformity. Traditionally, it is an open procedure with extensive soft tissue dissection. Arthroscopic triple arthrodesis would appear to provide good visualization and preparation of the fusion surfaces while preserving the soft tissue envelope. The purpose of this Technical Note is to describe a minimally invasive approach of triple arthrodesis to correct chronic flatfoot deformity.Endoscopic Synovectomy of Peroneal Tendon Sheath
Peroneal tenosynovitis usually responds to conservative therapy. Early diagnosis and management are imperative because improper or delayed diagnosis and treatment of peroneal tenosynovitis may lead to progression of the tenosynovitis to peroneal tendon rupture, ultimately limiting the benefit of nonoperative treatment. For refractory cases, endoscopic tenosynovectomy is indicated. The purpose of this Technical Note is to report a minimally invasive approach to perform a synovectomy of zones 1 and 2 of the peroneal tendon sheath.Endoscopic Stalk Resection of a Toe Ganglion With Color-aided Visualization
Ganglion cysts are common cystic lesions filled with a jelly-like substance and originate from a joint capsule or tendon sheath through a stalk. Ganglion cysts mostly occur in the hand region, for which surgical excision usually results in good outcomes. In contrast, toe ganglions are relatively rare, and surgical treatment is associated with a high recurrence rate because of unidentifiable ganglion stalks, requiring large skin incisions. We have treated toe ganglion cysts using endoscopy in the ganglion cyst by injecting methylene blue into the tendon sheath that connects to the ganglion stalk.Flexor Hallucis Longus Tenosynovitis and First Metatarsophalangeal Synovitis After Penetrating Nail Prick Injury: Treated by Zone 3 Flexor Hallucis Longus Tendoscopy and Metatarsosesamoid Arthroscopy
Pedal penetrating nail prick injury around the first metatarsal head can result in persistent synovitis of the first metatarsophalangeal joint and tenosynovitis of the flexor hallucis longus tendon. Exploration and debridement is indicated if the condition does not improve with antibiotics. Open surgery requires extensive dorsal and plantar incisions. The purpose of this Technical Note is to report the combined arthroscopic and tendoscopic approaches to address the first metatarsophalangeal joint and flexor hallucis longus tendon pathologies.Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure
The underlying reason for recurrence of hallux valgus deformity after bunion surgery is multifactorial and includes surgeon-based and patient-based factors as well as original components of deformity initially unaddressed at the index procedure. Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance.Endoscopic Adhesiolysis of Flexor Hallucis Longus Muscle
Adhesion of the flexor hallucis longus (FHL) muscle to the distal tibia can occur after distal tibial fracture, distal fibular fracture, low tibial osteotomy, soft-tissue injury at the posterior ankle, subclinical compartment syndrome of the distal deep posterior compartment of the leg, or Volkmann contracture after deep posterior compartment syndrome of the leg. The purpose of this Technical Note is to report the endoscopic approach of FHL muscle adhesiolysis. It is indicated in patients with symptomatic adhesion of the FHL muscle and contraindicated if there is entrapment of the FHL muscle or tendon in the fracture callus or if there is extensive fibrosis and contracture of the FHL muscle as a result of Volkmann contracture after deep posterior compartment syndrome of the leg.Endoscopic Resection of Giant Cell Tumor of the Extensor Tendon of the Foot
The localized form of giant cell tumor of the tendon sheath is one of the most common soft tissue tumors of the foot and ankle region. It is characteristically a benign, sharply localized peritendinous fibrous mass in the synovial or tendinous spaces. The purpose of this Technical Note is to present the technical details of endoscopic resection of giant cell tumor of the extensor tendon of the foot with preservation of the tendon. It is indicated in the localized form of giant cell tumor of the extensor tendon at the foot dorsum.Endoscopic Fusion of the Accessory Navicular Synchondrosis That Has No Diastasis
Accessory navicular bone is a common accessory ossicle of the foot and is present in 10% to 14% of normal feet. Less than 1% of the accessory navicular bones are symptomatic. Degenerative or traumatic disruption of the accessory navicular synchondrosis is one of the main causes of symptomatic accessory navicular. The disrupted synchondrosis may or may not be associated with diastasis of the synchondrosis. Fusion of the synchondrosis is indicated if the pain fails to respond to conservative measures.Ankle Arthroscopy With Microfracture for Osteochondral Defects of the Talus
Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. A full diagnostic arthroscopy is performed, and then attention is turned to the osteochondral defect. We describe in detail patient positioning, ankle distraction, portal placement, steps of the diagnostic arthroscopy, and the technique of microfracture. We then discuss the special considerations to be taken regarding the use of a distractor, protection of neurovascular structures, and the indications for microfracture.Arthroscopic Repair of Superomedial Spring Ligament by Talonavicular Arthroscopy
A spring ligament tear can occur because of failure of the tibialis posterior tendon in adult-acquired flatfoot deformity or as an isolated injury with a normal tibialis posterior tendon. The superomedial spring ligament is the most common site of rupture. Compromise of this ligament is a primary causative factor of peritalar subluxation, and a functioning tibialis posterior tendon cannot prevent or correct a planovalgus foot deformity. Therefore, the spring ligament should be repaired in addition to treatment of tibialis posterior tendon abnormalities.Endoscopic Resection of Dorsal Boss of the Second and Third Tarsometatarsal Joints
Dorsal boss of the foot also known as “tarsal boss,” “dorsal exostosis,” and “humped bone” is a bone spur that grows from one of the intertarsal or tarsometatarsal joints. It can occur with or without arthritis of the underlying joints. Surgery is indicated if the symptoms do not respond to conservative treatment. Excision of the dorsal boss with or without fusion of the underlying joint is the operative treatment of choice. We report an arthroscopic approach of resection of the dorsal exostosis.Arthroscopic Curettage and Bone Grafting of Bone Cysts of the Talar Body
Talar bone cysts can develop as a result of osteochondral lesions of the talus. This can be a source of deep ankle pain. Open debridement and bone grafting of the bone cysts requires extensive soft tissue dissection and malleolar osteotomy. Removal of normal cartilage of the talus is frequently required to approach the bone cysts. Alternatively, the cysts can be grafted arthroscopically with minimal disruption of the normal cartilage surface. The key to success is careful preoperative planning with a computed tomogram of the ankle.Arthroscopically Assisted Modified Jones Procedure
The modified Jones procedure is the classic operative treatment of symptomatic clawed hallux. It is composed of transfer of the extensor hallucis longus tendon to the first metatarsal neck and fusion of the hallux interphalangeal joint. The purpose of this technical note is to report the technique of an arthroscopically assisted modified Jones procedure. This can be combined with other minimally invasive bone and soft-tissue procedures to correct all aspects of the complex cavus foot deformity.
