The Foot
Volume 19, Issue 4 , Pages 218-221, December 2009

Arthroscopic release of flexor hallucis longus tendon using modified posteromedial and posterolateral portals in the supine position☆

  • John S. Theodoropoulos

      Affiliations

    • Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    • ,
  • Preston M. Wolin

      Affiliations

    • Center for Athletic Medicine, Chicago, IL, United States
    • ,
  • Drew W. Taylor

      Affiliations

    • Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    • Corresponding Author InformationCorresponding author at: Mount Sinai Hospital, 600 University Avenue, Suite 476C, Toronto, ON M5G 1X5, Canada. Tel.: +1 416 586 4800x8699; fax: +1 416 586 8501.

Received 23 June 2008; accepted 9 February 2009.

Abstract 

Background

The flexor hallucis longus (FHL) is a known site of pathological conditions. FHL stenosing tenosynovitis presents as posterior medial ankle pain or great toe discomfort and is often associated with a catching sensation of the great toe. There are a wide variety of open procedures for the treatment of FHL stenosing tenosynovitis.

Objective

Arthroscopic treatment may circumvent some of the complications associated with open surgical treatment of the hindfoot.

Methods

Arthroscopic surgery was completed in the supine position using modified posteromedial and posterolateral portals. A 70° arthroscope allowed for circumferential evaluation of the ankle through the posterolateral portal including the subtalar areas and the entire FHL tendon for release using basket forceps and a 3.5mm shaver.

Results

This method allows for decompression of the FHL from the entrance of the fibro-osseous tunnel to the knot of Henry. Active and passive range of motion of both the ankle and toes was encouraged postoperatively. The patient returned to sporting activity 6 weeks after surgery.

Conclusions

Endoscopic treatment of the FHL stenosing tenosynovitis is presented as an alternative to an open surgical procedure; it may reduce wound complications and may allow for an earlier return to sport.

Keywords: Flexor hallucis longus, Arthroscopy, Stenosing tenosynovitis, Release

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☆ The authors did not receive any outside funding nor were commissioned or supported by any outside agency for this case study.

PII: S0958-2592(09)00012-1

doi:10.1016/j.foot.2009.02.002

The Foot
Volume 19, Issue 4 , Pages 218-221, December 2009

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