Journal of Foot and Ankle Surgery (Asia Pacific)

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2022 | July-September | Volume 9 | Issue 3

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Panagiotis D Symeonidis

The New Era of Hindfoot Endoscopy and Tendoscopy

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:1] [Pages No:99 - 99]

   DOI: 10.5005/jp-journals-10040-1256  |  Open Access |  How to cite  | 


Mini Symposium

Panagiotis D Symeonidis, Ioannis Spanos, Pim AD van Dijk, Niek C van Dijk

Peroneal Tendoscopy: Applied Anatomy and Operative Technique

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:7] [Pages No:100 - 106]

Keywords: Anatomy, Minimally invasive, Peroneal, Peroneal tendons, Surgical technique, Tendoscopy

   DOI: 10.5005/jp-journals-10040-1245  |  Open Access |  How to cite  | 


Pathologies related to the peroneal tendons are responsible for the largest percentage of retrofibular ankle pain, including a wide spectrum of relevant diagnoses. Diagnosing peroneal tendon pathologies, however, remains challenging as the accuracy of imaging studies including ultrasound (US) and magnetic resonance imaging (MRI) is still limited by constricting factors including operator dependence for US and the magic angle effect in MRI. On the contrary, advances in technology and our knowledge of the regional anatomy have rendered tendoscopy a viable option for patients with a high clinical suspicion for peroneal tendon pathology but a lack of positive findings on imaging. For both diagnosis and treatment of these patients, peroneal tendoscopy is recommended. The aim of the current study is to present a step-by-step, state of the art manner to perform a peroneal tendoscopy in a safe and reproducible manner. As indications of the method expand, an increasing number of surgeons with experience in foot and ankle arthroscopy have the chance to incorporate peroneal tendoscopy in their armamentarium. A detailed description of the operative technique with reference to recent data from anatomical and cadaveric studies is presented. Moreover, tips and pearls from the authors’ accumulated experience are being highlighted. Finally, common pitfalls and limitations of the method are being discussed.



Chayanin Angthong, Cholawish Chanlalit, Henry R Handoyo

Hindfoot Endoscopic Treatments for the Pathologies of the Flexor Hallucis Longus and Achilles Tendons

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:107 - 111]

Keywords: Achilles tendon, Flexor hallucis longus, Hindfoot endoscopy

   DOI: 10.5005/jp-journals-10040-1237  |  Open Access |  How to cite  | 


Background: Hindfoot pathologies and injuries are commonly encountered in foot and ankle orthopedic practice. Despite the growing number of related studies on these topics, the knowledge on the development of key aspects of endoscopic surgeries for these conditions is still lacking. Review: This review aimed to present the current concepts and techniques of endoscopic surgery and related treatments for these pathologies and injuries, with a focus on flexor hallucis longus (FHL) and Achilles tendon pathologies or injuries.



Gabriel E Khazen

Stage I Posterior Tibial Tendon Dysfunction: Ten Years Follow-up after Endoscopic Treatment

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:4] [Pages No:112 - 115]

Keywords: Dysfunction, Posterior, Tendon, Tendoscopy, Tibial

   DOI: 10.5005/jp-journals-10040-1235  |  Open Access |  How to cite  | 


Stage I posterior tibial tendon dysfunction (PTTD) is tenosynovitis or tendinitis without hindfoot deformity, for this reason, this condition can be misdiagnosed delaying correct treatment that may improve patient symptoms and probably stop disease progression to the next stage and flatfoot deformity. After diagnosis conservative treatment is indicated, if symptoms persist it has been recommended PTT surgical debridement and synovectomy, which can be performed endoscopically to avoid soft-tissue complications. PTT tendoscopy should be indicated early after diagnosis if patient symptoms do not improve or get worst with conservative treatment. After 10 years of follow-up, 75% of our patients treated for stage I PTTD did not progress to stage II either if they had tendon tears or not.



Damjan Dimnjaković, Igor Knežević, Ivan Bojanić

Tendoscopic Advantages for Managing Peroneal Intrasheath Subluxations

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:7] [Pages No:116 - 122]

Keywords: Intrasheath subluxation, Peroneal tendons, Tendoscopy

   DOI: 10.5005/jp-journals-10040-1240  |  Open Access |  How to cite  | 


Aim: Peroneal intrasheath subluxations are recalcitrant to nonsurgical management. Surgical treatment can be either open or tendoscopic. This study aimed to explore the advantages of tendoscopic treatment for peroneal intrasheath subluxations. Materials and methods: Patients who underwent peroneal tendoscopy to treat the intrasheath subluxations in our department between January 2013 and December 2020 were included in the study. The procedures were performed in a standardized fashion, in a lateral decubitus position, with a 4.5-mm and 30-degree arthroscope, gravity irrigation system, and standard arthroscopic instruments. A thigh tourniquet was always set in place but was not inflated in all patients. The procedures were performed consistently through standard portals described by van Dijk and Kort. The performed procedures included removing low-lying peroneus brevis muscle belly (LLMB), removing peroneus quartus (PQ) muscle, or retrofibular groove deepening. Results: Eleven consecutive patients (5 males and 6 females) with a mean age of 20.0 (range 10–40) years were included in the study. Low-lying peroneus brevis muscle belly was identified in nine patients, while PQ muscle was identified in one case. A flat or convex retrofibular groove was noticed in three cases, one of them without any evident space-occupying lesions. No perioperative complications were reported. The mean American Orthopedic Foot and Ankle Society (AOFAS) score increased from 81 preoperatively to 99 postoperatively. Conclusion: Although some believe that peroneal tendoscopy is a highly technically demanding procedure with limited utility, its efficacy and safety were demonstrated in this study supported by published literature results. Therefore, we believe that it is the method of choice for treating intrasheath peroneal subluxations. Clinical significance: The results of this study suggest that peroneal tendoscopy could be effectively used for treatment of peroneal intrasheath subluxations, as it has been used for the treatment of various peroneal tendons’ pathology.



Manuel Monteagudo, Pilar Martínez de Albornoz

Posterior Tibial Tendoscopy in Flexible Acquired Flatfoot Deformity

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:123 - 127]

Keywords: Collapsing foot, Endoscopy, Flatfoot, Magnetic resonance imaging, Posterior tibial tendon, Retrospective cohort study, Synovectomy, Tendoscopy

   DOI: 10.5005/jp-journals-10040-1241  |  Open Access |  How to cite  | 


Tendoscopy is a reliable and safe technique to manage some foot and ankle disorders. The technique allows for a view of the entire length of tendons and may be used as an isolated procedure or adjacent to other techniques, such as calcaneal osteotomy. Posterior tibial tendoscopy is a useful tool both for the diagnosis and treatment of different disorders that affect the tendon in isolation (i.e., post-traumatic) or in the scenario of a flatfoot deformity. We will review the technique of posterior tibial tendoscopy and present tips and tricks to optimize the tendoscopic experience. We will also analyze our first 20 consecutive cases of posterior tibial tendoscopy in the setting of a flexible flatfoot deformity and study our data and results. In 10 cases, there were no significant pathological findings on magnetic resonance imaging (MRI) or on tendoscopy. In six cases, synovitis and adhesions were informed on MRI and found on tendoscopy. Preoperative MRI findings were coincident with tendoscopic findings in 16 of the 20 cases (80%). MRI failed to identify two cases of synovitis, a case of synovial plica and suggested a partial tear where tendoscopy demonstrated no structural damage. Although MRI is an effective imaging tool for identifying tendon disorders, tendoscopy seems to be a more sensitive diagnostic tool. Posterior tibial tendon (PTT) tendoscopy has become our procedure of choice in stage IIA AAFD and has allowed us to treat PTT disorders when skipping the medial soft tissue repair with no impact on outcomes while addressing pathology that might cause symptoms if left untreated.


Technique Article

Steven DeFroda, Andrew Gil, Joe Harris, Gregory R Waryasz

An Effective Bedside Lavage Technique for Management of Septic Arthritis of the Ankle

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:2] [Pages No:128 - 129]

Keywords: Bacteremia, Hematogenous infection, Infection, Joint lavage, Septic ankle, Septic arthritis

   DOI: 10.5005/jp-journals-10040-1233  |  Open Access |  How to cite  | 


Septic arthritis of the ankle can result in short- and long-term disabilities and fatal complications if not addressed promptly. Urgent arthroscopic or open joint lavage is the standard of care in cases with septic arthritis. However, this may be delayed in older patients with comorbidities and immunocompromised individuals, for achieving preoperative optimization. To counter such situations, we present a simple and effective bedside joint lavage technique that relies on continuous irrigation and suction and can therefore prevent unwarranted delays in the operative management of these cases.



Amit Bishnoi, Maneesh Bhatia

Current Concepts in Acute Achilles Tendon Injury

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:130 - 134]

Keywords: Achilles tendon, Achilles tendon repair, Achilles tendon rupture

   DOI: 10.5005/jp-journals-10040-1260  |  Open Access |  How to cite  | 


Introduction: Tendon Achilles injury is a common foot and ankle injury in the middle-aged population, especially between the age group of 30–46 years. This is important to recognize early and treat as salvage options have consistently poor outcomes. The incidence of acute tendon rupture (ATR) is on rising worldwide. Men are more prone to ATR when they try to get back to some fitness in the middle ages by playing dynamic sports like badminton, tennis, etc. We looked at the current concepts in the management of acute tendon Achilles injury. Method: We looked at the evidence of management, both surgical and nonsurgical options in detail and discussed the pros and cons of each modality. There are both advantages and disadvantages but the new evidence is tilting toward functional rehabilitation. Conclusion: This provides a systemic approach to clinicians in decision-making about the management of ATR in their patient group and recommends functional treatment as our choice in the majority of patient groups.


How to Do it

Rajiv Shah, Siddharth Sharma, Shivam R Shah

Management of Rigid Post-poliomyelitis Equinocavovarus Deformities: A Brief Review

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:7] [Pages No:135 - 141]

Keywords: Equinocavovarus deformity, Foot and ankle deformity, Neglected foot and ankle deformities, Poliomyelitis

   DOI: 10.5005/jp-journals-10040-1173  |  Open Access |  How to cite  | 


Foot and ankle deformities are frequent in patients with post-polio residual paralysis (PPRP), and can be attributed to abnormal muscle balance, abnormal posture, gravitation forces, and continued walking over the deformed foot. Equinocavovarus is the most common foot and ankle deformity in PPRP patients. Late presenting or neglected deformities can lead to gait abnormalities, abnormal pressure areas, increased energy expenditure, and arthritis of foot joints. Management of post-poliomyelitis equinocavovarus requires an in-depth understanding of the pathoanatomy as well as the interplay of muscle dynamics.



Zixing Bai, Xuhan Cao, Yanjun Yang, Chengyi Sun, Si Chen, Haiwei Hu, Jianmin Wen, Xinxiao Lin, Weidong Sun

Comparing Clinical Efficacy between Minimally Invasive Osteotomy and Weil Osteotomy for Treatment of Metatarsalgia

[Year:2022] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:142 - 146]

Keywords: Foot, Metatarsalgia, Minimally invasive, Osteotomy

   DOI: 10.5005/jp-journals-10040-1164  |  Open Access |  How to cite  | 


Background: Both minimally invasive osteotomy and Weil osteotomy can effectively relieve pain symptoms of metatarsal pain, but their indications and clinical efficacy lack data support. Aim and objective: To investigate the differences of indications and clinical efficacy between the minimally invasive osteotomy and the Weil osteotomy for treatment of the metatarsalgia. Materials and methods: One hundred and four metatarsal bones in 64 feet of 51 patients with mild metatarsalgia were divided into two groups. The minimally invasive osteotomy and elevation of metatarsal operation were performed on the 24 patients in group I, a total of 55 metatarsal bones of 26 feet. The Weil osteotomies were performed on the 27 patients in group II, a total of 49 metatarsal bones of 38 feet. The visual analog scale/score (VAS), the American College of Foot and Ankle Surgeons (ACFAS), the maximum plantar force, the peak pressure, and the force-time integrals of the target metatarsals were compared between preoperation and postoperation, respectively. Results: All test data, such as the VAS, the ACFAS, the maximum plantar force, the peak pressure, and the force-time integrals under the target metatarsal heads after osteotomy, were significantly different (p < 0.05) from those before osteotomy in both groups. However, all the above data were not significantly different between the two groups (p > 0.05). Four metatarsals were reported to have a delayed bone healing after the minimally invasive osteotomy. Conclusion: Both osteotomies can effectively release the pain. The minimally invasive osteotomy is easy to handle and has the advantages such as less complication, low cost, and a low requirement on equipment, which can be suggested to be widely used in the basic level hospital.


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