Tenotomy, percutaneous, Achilles tendon
The physician performs a percutaneous tenotomy of the Achilles tendon. The physician infiltrates the skin and Achilles tendon with a local anesthetic about 1 cm above the insertion into the calcaneus. A knife blade or tenotome held vertically is inserted through the skin and subcutaneous tissue into the Achilles tendon. The blade is turned medially and laterally and swept back forth, creating a nick in the tendon, until the foot can be dorsiflexed at the ankle. Pressure is applied over the incision for about five minutes. A dressing and long leg cast is applied with the ankle in ten degree dorsiflexion and the knee in maximal extension.
Resection, condyle(s), distal end of phalanx, each toe
The physician resects the condyle of the distal end of the phalanx, amputating the toe. The physician makes a curvilinear incision to fashion "fish-mouth" skin flaps side-to-side or dorsally to plantarly. The amputation can be done as a disarticulation or by resecting through the bone. If the head of the toe is disarticulated, the capsular ligaments are severed and the distal phalanx is removed. The capsule is approximated with sutures. If the bone is resected, a power saw is used to transect the proximal phalanx. A drain may be used. The skin flaps are approximated with sutures and a compression dressing is applied.
Bunionectomy
The physician treats a bunion of the foot with an osteotomy, a cut in the first metatarsal bone. The physician makes an incision in the skin over the top of the foot at the base of the big toe. Depending on the particular osteotomy to be performed, the incision may be made over the medial (inside) of the foot; or two separate incisions may be made. The incision is carried deep to the bone. Tissue is dissected and debrided as needed. The bony eminence, or bunion, is removed from the first metatarsal head. The physician cuts through the bone, performing the desired osteotomy. The pieces of bone are realigned to their correct position. Fixation devices may hold the bone fragments in position. The wound is closed in layers after thorough irrigation
Osteotomy
A dorsomedial incision is made over the big toe and the skin and soft tissues are reflected. In many cases this procedure is performed in an effort to correct the poor alignment of the big toe. In addition to removal of the medial eminence, a cut is made through the metatarsal shaft and a portion of the bone is removed in order to correct the alignment of the bone. Wires are used to reattach the bone in its corrected alignment. Sutures are used to close the incision. Weight bearing is protected for several weeks.
Endoscopic plantar fasciotomy
The physician performs a plantar fasciotomy using an endoscope. The patient is placed prone. After administering a local anesthetic, the physician makes a small incision to create a passage for the endoscope. Other incisions are made as needed for additional instruments. One or more transverse divisions of the contracted and fibrotic cord(s) of plantar fascia in the foot are performed for therapeutic release. The instruments are removed and the wound closed with simple or layered sutures
