1/3. Arthroscopic Keller technique for Freiberg disease.Freiberg disease is a disorder that has a predilection for the second metatarsal head. Keller excision of the base of the proximal phalanx is a procedure described for the treatment of late-stage Freiberg disease. We describe a case of a 60-year-old man, with a stage IV lesion according to Smillie's classification, treated by debridement, removal of the free body, and arthroscopic Keller excision. Arthroscopic treatment allows the patient to begin and maintain an aggressive postoperative physical therapy program immediately after surgery, thus decreasing the risk of scarring and contracture. At last evaluation, 2 years postoperatively, he is symptom-free. A suggested pattern of minimally invasive surgery management of this disease is proposed. ( info) |
2/3. role of toe flexor tendoscopy in management of an unusual cause of metatarsalgia.The purpose of this study is to describe an endoscopic approach to toe flexor tendons at the level of metatarsal head region. And this study is a kind of retrospective case series. Three patients with toe flexor tenosynovitis were evaluated after a follow-up of 2 years after toe flexor tendoscopy. One patient suffered from infective toe flexor tendosynovitis resulting from a penetrating injury and other two patients suffered from idiopathic focal toe flexor tenosynovitis. Pre-operative metatarsalgia subsided after toe flexor tendoscopy. No endoscopy-related complication was observed. Toe flexor tendoscopy can be an effective operative means in the management of focal toe flexor tenosynovitis. ( info) |
3/3. Arthroscopic Lapidus arthrodesis.Lapidus arthrodesis is the surgical treatment of choice for symptomatic hypermobility of the medial cuneiform metatarsal joint that is not responding to conservative treatment. The open procedure was criticized for its prolonged healing, high nonunion rate, and the tendency for dorsal angulation of the first metatarsal. We describe an arthroscopic approach that has the advantage of more thorough preparation of the fusion site with minimal bone removal and better control of the arthrodesis position and with less chance of malunion. ( info) |