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Endoscopic Subtotal Fasciectomy of the Foot

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1 Endoscopic Subtotal Fasciectomy of the Foot
Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S.  Arthroscopy Techniques  Volume 5, Issue 6, Pages e1387-e1393 (December 2016) DOI: /j.eats Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

2 Fig 1 Endoscopic subtotal fasciectomy of the right foot. (A) Clinical photograph of the illustrated case shows the 2 plantar fibromata (arrowheads). (B) Sagittal view of magnetic resonance imaging shows the proximal fibroma (arrowhead). (C) Sagittal view of magnetic resonance imaging shows the distal fibroma (arrowhead). (D) Coronal view of magnetic resonance shows that the lesion does not invade to the skin nor the underlying muscle (arrowhead). Arthroscopy Techniques 2016 5, e1387-e1393DOI: ( /j.eats ) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

3 Fig 2 Endoscopic subtotal fasciectomy of the right foot. The fibroma (F) and the planned area of resection (AR) of the plantar aponeurosis are outlined on the plantar skin. The resection margins are approximately 1.5 cm around the tumor except at the medial side that is limited by the medial edge of the plantar aponeurosis. The proximal medial (PMP) and distal medial (DMP) portals are located at the proximal and distal ends of the medial edge of the AR, respectively. Arthroscopy Techniques 2016 5, e1387-e1393DOI: ( /j.eats ) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

4 Fig 3 Endoscopic subtotal fasciectomy of the right foot. The proximal medial portal is the viewing portal. The subcutaneous tissue over the AR is stripped from the aponeurosis by a small periosteal elevator (A) or an arthroscopic shaver (B) via the distal medial portal. (AR, planned area of resection of the plantar aponeurosis; DMP, distal medial portal; F, fibroma; PA, plantar aponeurosis; PMP, proximal medial portal; ST, subcutaneous tissue.) Arthroscopy Techniques 2016 5, e1387-e1393DOI: ( /j.eats ) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

5 Fig 4 Endoscopic subtotal fasciectomy of the right foot. The proximal medial portal is the viewing portal. (A) The light spot should go along the lateral outline of the AR. (B) The lateral edge of the AR is released by an arthroscopic shaver. (AR, planned area of resection of the plantar aponeurosis; DMP, distal medial portal; LE, lateral edge of planned resection area; M, muscles deep to the plantar aponeurosis; PA, plantar aponeurosis; PMP, proximal medial portal; ST, subcutaneous tissue.) Arthroscopy Techniques 2016 5, e1387-e1393DOI: ( /j.eats ) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

6 Fig 5 Endoscopic subtotal fasciectomy of the right foot. (A) The distal medial portal (DMP) is the viewing portal. The medial edge (ME) of the plantar aponeurosis is released by a retrograde knife via the proximal medial portal (PMP). (B) The PMP is the viewing portal. The ME of the plantar aponeurosis is released by an arthroscopic scissors via the DMP. (DF, deep fascia over the hallucis abductus muscle; PA, plantar aponeurosis.) Arthroscopy Techniques 2016 5, e1387-e1393DOI: ( /j.eats ) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

7 Fig 6 Endoscopic subtotal fasciectomy of the right foot. Two sets of stay stitches (SS) are applied to the aponeurosis just distal to the proximal edge of the AR with No. 1 PDS sutures (Ethicon) by an eyed needle. The plantar aponeurosis (PA) is cut proximal to the stay stitches. (AR, planned area of resection of the plantar aponeurosis; PMP, proximal medial portal.) Arthroscopy Techniques 2016 5, e1387-e1393DOI: ( /j.eats ) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

8 Fig 7 Endoscopic subtotal fasciectomy of the right foot. (A) A small-sized suction tip is passed from the distal medial portal to the proximal medial portal (PMP). This serves as the conduit for the passage of the stay stitches to the distal medial portal (DMP). (B) The plantar aponeurosis is then retracted toward the DMP by pulling the stay stitches. (C) The PMP is the viewing portal. The underlying muscle is stripped from the aponeurosis by a small periosteal elevator via the DMP. (M, muscles deep to the plantar aponeurosis; PA, plantar aponeurosis; ST, subcutaneous tissue.) Arthroscopy Techniques 2016 5, e1387-e1393DOI: ( /j.eats ) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

9 Fig 8 Endoscopic subtotal fasciectomy of the right foot. (A) The plantar aponeurosis (PA) together with the fibroma is retracted out of the distal medial portal (DMP). The distal edge of the planned area of resection of the plantar aponeurosis (AR) is cut outside the DMP. (B) The resected PA. Arthroscopy Techniques 2016 5, e1387-e1393DOI: ( /j.eats ) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions


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