Lateral foot pain following open reduction and internal fixation of the fracture of the fifth metatarsal tubercle: treated by arthroscopic arthrolysis and endoscopic tenolysis

Arthroscopic Arthrodesis of the Lesser Ray Tarsometatarsal Joints: 2-Portal Technique

Tarsometatarsal (Lisfranc) destruction of the tarsometatarsal articulation of the lesser rays is most commonly due to midfoot Charcot neuroarthropathy. Tarsometatarsal arthrodesis is indicated when conservative management cannot relieve the symptoms. The purpose of this Technical Note is to describe a minimally invasive approach of arthroscopic arthrodesis of the destructed lesser ray tarsometatarsal joints. The arthroscopic procedure is performed through the lateral and P1-2 Lisfranc portals. It has the advantages of better cosmesis, less wound complication, less bone resection, and more thorough joint debridement. However, it is contraindicated if there is associated significant foot deformity or shortening of the lesser foot rays.

Endoscopic Synovectomy of Peroneal Tendon Sheath

Peroneal tenosynovitis usually responds to conservative therapy. Early diagnosis and management are imperative because improper or delayed diagnosis and treatment of peroneal tenosynovitis may lead to progression of the tenosynovitis to peroneal tendon rupture, ultimately limiting the benefit of nonoperative treatment. For refractory cases, endoscopic tenosynovectomy is indicated. The purpose of this Technical Note is to report a minimally invasive approach to perform a synovectomy of zones 1 and 2 of the peroneal tendon sheath.

Arthroscopic Tarsometatarsal Arthrodesis

Tarsometatarsal (Lisfranc) osteoarthritis can be a disabling condition and is commonly due to posttraumatic causes. Tarsometatarsal arthrodesis is indicated if the pain does not subdue with conservative treatment. Classically, this is performed as an open procedure. The purpose of this technical note is to describe a minimally invasive approach of arthroscopic arthrodesis of the involved tarsometatarsal joints. The arthroscopic procedure is performed through the junction portals of the involved articulation. It has the advantages of better cosmesis, less wound complication, less bone resection, and more thorough joint debridement. However, it is contraindicated if there is an associated significant foot deformity or shortening of the involved foot rays.

Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications

Context

Fractures of proximal fifth metatarsal are one of the most common fractures of the foot.

Evidence Acquisition

A search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies.

Results

The vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report.

Conclusions

Lawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.

Arthroscopic Lysis of Arthrofibrosis of the Fifth Tarsometatarsal Joint

Loss of motion of the fifth tarsometatarsal joint can be a cause of lateral foot pain after Lisfranc fracture-dislocation or fracture of the fifth metatarsal tubercle. Arthroscopic lysis of the joint can be an effective surgical treatment with the advantage of minimal soft-tissue trauma and early vigorous mobilization of the joint. The lysis can be extended to the fourth tarsometatarsal joint and the adjacent tendons if indicated.

Small joint arthroscopy in foot and ankle

The clinical application of small joint arthroscopies (metatarsophalangeal joint, Lisfranc joint, Chopart joint, and interphlangeal joint) in the foot has seen significant advancements in the past decades. This article reviews the clinical indications, technical details, outcomes, and potential complications of small joint arthroscopies of the foot.

Peroneal tendoscopy

Peroneal tendoscopy is indicated for peroneal tenosynovitis, subluxation or dislocation, snapping, partial tears requiring debridement, and postoperative adhesions and scarring. Peroneal tendoscopy was also found to be valuable as a diagnostic tool in some instances. It is generally reported to have good to excellent outcomes in most patients with a relatively low occurrence of complications.