Arthroscopic and Endoscopic Management of Posttraumatic Hindfoot Stiffness

Abstract

Ankle, hindfoot, and toe stiffness can result from hindfoot trauma. It can be due to capsular fibrosis, tendon adhesion, muscle fibrosis, or malunion. For symptomatic stiffness that is resistant to nonoperative treatment, operative treatment should be considered. It is important to tackle the sources of stiffness, and careful preoperative clinical assessment is the key for proper formulation of the surgical plan. Whenever possible, arthroscopic/endoscopic surgery is preferable to open surgery because less extensive dissection and small surgical incisions allow immediate vigorous mobilization of the foot and ankle.

History of foot and ankle arthroscopy

“…ASA is now recommended over open procedures for its therapeutic benefits in decreasing infection and nonunion rates. [31,37,38] With access to subtalar and talonavicular joints possible, the applications and scope of arthroscopy in this area have widened. Arthroscopic management of post-traumatic hindfoot stiffness due to capsular fibrosis, tendon adhesions and even calcaneal malunions leading to decrease inversion, has been described by Lui et al [37] Interchangeable portals such as medial and dorsomedial midtarsal portal provide reasonable access to the talonavicular joint; medial midtarsal and medial tarsal canal portals are useful for medial subtalar arthroscopy for stiffness cases [ Figure 4].…”

“…Arthroscopic management of post-traumatic hindfoot stiffness due to capsular fibrosis, tendon adhesions and even calcaneal malunions leading to decrease inversion, has been described by Lui et al [37] Interchangeable portals such as medial and dorsomedial midtarsal portal provide reasonable access to the talonavicular joint; medial midtarsal and medial tarsal canal portals are useful for medial subtalar arthroscopy for stiffness cases [ Figure 4]. [37]…”

Arthroscopic Resection of Too-Long Anterior Process (TLAP) of the Calcaneus, Anterior Subtalar Synovectomy, Debridement of the Sinus Tarsi, and Posterior Subtalar Adhesiolysis Via Anterolateral Subtalar and Dorsolateral Midtarsal Portals

“…Arthroscopic release of the joint is an effective treatment means if conservative treatment fails to eliminate the pain. 16,17 In this Technical Note, we report the 2-portal arthroscopic approach of resection of TLAP lesion, anterior subtalar synovectomy, debridement of the sinus tarsi, and posterior subtalar adhesiolysis. It is indicated in recalcitrant symptomatic TLAP lesion, sinus tarsi syndrome, and arthrofibrosis of the posterior subtalar joint.…”

“…Arthroscopic release of the joint is an effective treatment means if conservative treatment fails to eliminate the pain. 16 , 17 …”

Complex Hindfoot and Ankle Trauma: The Management Status in 2018

“…Hindfoot stiffness is common after trauma, and the methodology of using arthroscopic surgery to treat such cases opens new avenues in the management. Although associated with a high learning curve and the need for specialized equipment, the techniques described by Lui TH 15 in this symposium are in tune with modern management protocols, as the minimally invasive methods used allow for early and vigorous rehabilitation after surgery.…”