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Roos N, Mahlaola TB, Hazell L. Cut-off value for a normal posterior tibial nerve to diagnose tarsal tunnel syndrome amongst people of different race in Pretoria, South Africa. J Med Radiat Sci 2024. [PMID: 38641991 DOI: 10.1002/jmrs.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/06/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Posterior tibial nerve (PTN) cross-sectional area (CSA) reference values for the diagnosis of tarsal tunnel syndrome (TTS) using ultrasound imaging exist in several countries but not in South Africa (SA). Therefore, the objective was to measure the CSA reference values for PTN in SA. METHODS Ultrasound CSA measurements of PTN in both ankles on 112 participants were performed, the mean measurement was recorded, and the effect of race, age, gender, and body mass index (BMI) were recorded. RESULTS In this study, the primary variables age and BMI affect the CSA measurement of the PTN. A positive correlation was found between PTN asymptomatic size and age (r = 0.196, P < 0.05), size and BMI (r = 0.200, P < 0.05). Age (categories) had a mean value of 3.17 for the age group 36-45 years (95% confidence interval (CI) 2.9-3.4). The mean BMI was 30.0 kg/m2 (CI 28.57-31.08). As for the asymptomatic PTN, a mean CSA reference value of 0.10 cm2 was obtained. CONCLUSION With increase in age and BMI, a greater PTN measurement will occur. Race appears to be a contributing factor, but further research is needed in this regard. The reference CSA value for normal PTN should be set at 0.10 cm2 for all racial groups for a basic musculoskeletal ultrasound exam protocol in South Africa.
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Affiliation(s)
- Natasha Roos
- Dr Scholtz & Partners Radiology Department, Montana Hospital, Pretoria, South Africa
| | - Tintswalo Brenda Mahlaola
- Department of Medical Imaging and Radiation Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Lynne Hazell
- Department of Medical Imaging and Radiation Sciences, University of Johannesburg, Johannesburg, South Africa
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Iborra A, Villanueva M, Fahandezh-Saddi Díaz H. Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II-clinical results. J Orthop Surg Res 2024; 19:203. [PMID: 38532430 DOI: 10.1186/s13018-024-04685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/16/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens. METHODS AND RESULTS We performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18-64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle. RESULTS Ankle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months. CONCLUSION Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses.
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Affiliation(s)
- A Iborra
- Institute Avanfi, 28020, Madrid, Spain
- Unit for Ultrasound‑Guided Surgery, Hospital Beata Maria Ana, Madrid, Spain
- Department of Podiatry, Faculty of Health Sciences, University of La Salle Madrid, Madrid, Spain
- Unit of Foot and Ankle Surgery, Hospital La Zarzuela, Madrid, Spain
| | - M Villanueva
- Institute Avanfi, 28020, Madrid, Spain
- Unit for Ultrasound‑Guided Surgery, Hospital Beata Maria Ana, Madrid, Spain
- Unit of Foot and Ankle Surgery, Hospital La Zarzuela, Madrid, Spain
| | - H Fahandezh-Saddi Díaz
- Institute Avanfi, 28020, Madrid, Spain.
- Unit for Ultrasound‑Guided Surgery, Hospital Beata Maria Ana, Madrid, Spain.
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Turner A, Wang J, Liu G, Wukich D, VanPelt M. Retrospective Evaluation of Ultrasound Guided Percutaneous Plantar Fasciotomy With and Without Platelet Rich Plasma. J Foot Ankle Surg 2024; 63:233-236. [PMID: 38043602 DOI: 10.1053/j.jfas.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
Plantar fasciitis is one of the most common foot conditions presenting to a foot and ankle specialist. Surgical treatment outcomes following plantar fasciotomy vary but short-term studies have reported excellent early pain relief and significant improvements in symptoms. This study evaluates patient reported pain scores collected pre- and post-op for patients who underwent percutaneous ultrasonic microtenotomy (PUT) plantar fasciotomy with PRP injection vs without the use of PRP. We compared pain visual analog scale (VAS) scores, for patients treated surgically by Orthopedic Surgery department of foot and ankle faculty members between December 2007 and December 2022. A total of 30 patients were identified that met inclusion and exclusion criteria. Our results showed that there was a significant decrease in pain VAS scores from pre-op visit (at least 1 month prior to operation) to post-op visit (at least 1 month following operation) for both groups, with a paired t test (p value <.0001). However, patients who received PRP had a statistically significant decrease in pain level compared to the group who did not receive PRP. Statistical analysis completed with a 2-sample t test (p-value <.0325). Our results found the mean time between the initial pre-op visit and last post-op follow-up visit was 19 months. The mean for time following surgical intervention was 10 months. The findings of our study suggest that the dual use of PUT and PRP to treat plantar fasciitis, could potentially lead to an improvement in pain reduction and longevity of pain relief.
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Affiliation(s)
- Alexander Turner
- Medical Student University of Texas Southwestern Medical Center, Dallas, TX.
| | - Jijia Wang
- Department of Applied Clinical Research, Southwestern School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
| | - George Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael VanPelt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Koketsu K, Kim K, Tajiri T, Isu T, Morimoto D, Kokubo R, Dan H, Morita A. Ganglia-Induced Tarsal Tunnel Syndrome. J NIPPON MED SCH 2024; 91:114-118. [PMID: 38462440 DOI: 10.1272/jnms.jnms.2024_91-203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel. METHODS Between August 2020 and July 2022, we operated on 117 sides with TTS. This retrospective study examined data from 8 consecutive patients (8 sides: 5 men, 3 women; average age 67.8 years) with an extraneural ganglion in the tarsal tunnel. We investigated the clinical characteristics and surgical outcomes for these patients. RESULTS The mass was palpable through the skin in 1 patient, detected intraoperatively in 1 patient, and visualized on MRI scanning in the other 6 patients. Symptoms involved the medial plantar nerve area (n = 5), lateral plantar nerve area (n = 1), and medial and lateral plantar nerve areas (n = 2). The interval between symptom onset and surgery ranged from 4 to 168 months. Adhesion between large (≥20 mm) ganglia and surrounding tissue and nerves was observed intraoperatively in 4 patients. Of the 8 patients, 7 underwent total ganglion resection. There were no surgery-related complications. On their last postoperative visit, 3 patients with a duration of symptoms not exceeding 10 months reported favorable outcomes. CONCLUSIONS Because ganglia eliciting TTS are often undetectable by skin palpation, imaging studies may be necessary. Early surgical intervention appears to yield favorable outcomes.
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Affiliation(s)
- Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Kyongsong Kim
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | | | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital
| | | | - Rinko Kokubo
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Hiroyuki Dan
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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Khodatars D, Gupta A, Welck M, Saifuddin A. An update on imaging of tarsal tunnel syndrome. Skeletal Radiol 2022; 51:2075-2095. [PMID: 35562562 DOI: 10.1007/s00256-022-04072-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/02/2023]
Abstract
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the tibial nerve (TN) within the tarsal tunnel (TT) at the level of the tibio-talar and/or talo-calcaneal joints. Making a diagnosis of TTS can be challenging, especially when symptoms overlap with other conditions and electrophysiological studies lack specificity. Imaging, in particular MRI, can help identify causative factors in individuals with suspected TTS and help aid surgical management. In this article, we review the anatomy of the TT, the diagnosis of TTS, aetiological factors implicated in TTS and imaging findings, with an emphasis on MRI.
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Affiliation(s)
- Davoud Khodatars
- Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Ankur Gupta
- Foot and Ankle Orthopaedic Surgery Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Matthew Welck
- Foot and Ankle Orthopaedic Surgery Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK
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KIM K, KOKUBO R, ISU T, NARIAI M, MORIMOTO D, KAWAUCHI M, MORITA A. Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome. Neurol Med Chir (Tokyo) 2022; 62:552-558. [PMID: 36184477 PMCID: PMC9831623 DOI: 10.2176/jns-nmc.2022-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Tarsal tunnel syndrome (TTS) is a common entrapment syndrome whose diagnosis can be difficult. We compared preoperative magnetic resonance imaging (MRI) and operative findings in 23 consecutive TTS patients (28 sides) whose mean age was 74.5 years. The 1.5T MRI sequence was 3D T2* fat suppression. We compared the MRI findings with surgical records and intraoperative videos to evaluate them. MRI- and surgical findings revealed that a ganglion was involved on one side (3.6%), and the other 27 sides were diagnosed with idiopathic TTS. MRI visualized the nerve compression point on 23 sides (82.1%) but failed to reveal details required for surgical planning. During surgery of the other five sides (17.9%), three involved varices, and on one side each, there was connective tissue entrapment or nerve compression due to small vascular branch strangulation. MRI studies were useful for nerve compression due to a mass lesion or idiopathic factors. Although MRI revealed the compression site, it failed to identify the specific involvement of varices and small vessel branches and the presence of connective tissue entrapment.
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Affiliation(s)
- Kyongsong KIM
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan,Department of Neurosurgery, Chiba Shintoshi Rurban Clinic, Inzai, Chiba, Japan
| | - Rinko KOKUBO
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan
| | - Toyohiko ISU
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan
| | - Michinori NARIAI
- Department of Radiology, Chiba Shintoshi Rurban Clinic, Inzai, Chiba, Japan
| | - Daijiro MORIMOTO
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Masaaki KAWAUCHI
- Department of Neurosurgery, Chiba Shintoshi Rurban Clinic, Inzai, Chiba, Japan
| | - Akio MORITA
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Villanueva M, Iborra Á, Fahandezh-Saddi H, Sanz-Ruiz P, Noriega C. Ultrasound-guided aponeurotomy and interphalangeal joint capsular release for treatment of Dupuytren's disease. J Hand Surg Eur Vol 2022; 47:742-749. [PMID: 35249414 DOI: 10.1177/17531934221083815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study describes a new ultrasound-guided surgical technique for aponeurotomy and interphalangeal joint capsular release in patients with Dupuytren's disease and analyses the clinical outcomes. We carried out a retrospective review of 70 digits in 35 patients who underwent ultrasound-guided aponeurotomy and interphalangeal joint capsular release, with a minimum follow-up of 2 years. The primary outcome was the correction of the deformity and the QuickDASH questionnaire score after surgery and at 1 and 2 years. The secondary outcome was the presence of residual contracture immediately after surgery. The mean QuickDASH score fell from 28 before surgery to 14 after surgery. A significant decrease of -63° was observed for the global contracture, -35° the metacarpophalangeal joint contracture and -28° for the proximal interphalangeal joint contracture. Ultrasound-guided aponeurotomy and interphalangeal joint capsular and palmar plate releases are highly accurate and safe.Level of evidence: IV.
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Affiliation(s)
- Manuel Villanueva
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Madrid, Spain
| | - Álvaro Iborra
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Madrid, Spain
| | - Homid Fahandezh-Saddi
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Madrid, Spain
| | - Pablo Sanz-Ruiz
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Madrid, Spain.,Orthopaedic and Trauma Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Noriega
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Madrid, Spain.,Department of Nursing and Physiotherapy, University of Alcalá, Madrid, Spain
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Ultrasound-Guided Near-Nerve Needle Sensory Technique for the Diagnosis of Tarsal Tunnel Syndrome. J Clin Med 2021; 10:jcm10143065. [PMID: 34300231 PMCID: PMC8303982 DOI: 10.3390/jcm10143065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Tarsal tunnel syndrome (TTS) is one of the most common entrapment syndromes. Although diagnosis is supported by imaging tests, it has so far been based on clinical findings. Neurophysiological tests are not effective for providing an accurate diagnosis. The objective of this study was to analyze the efficacy of the ultrasound-guided near-nerve needle sensory technique (USG-NNNS) for the diagnosis of TTS Methods: The study population comprised 40 patients referred for a neurophysiological study owing to clinical suspicion of TTS. Routine neurophysiological tests were performed and compared with the results of USG-NNNS. Results: The diagnosis of TTS was achieved in 90% of cases. We found significant differences between lateral plantar sensory recordings with surface electrodes and USG-NNNS techniques for amplitude, nerve conduction velocity (NCV), and duration. As for the medial plantar sensory recordings, differences were found only for duration. No responses were obtained with surface electrode studies in 64.8% of cases. In addition, we observed normal sensory NCV with surface electrodes in 20 patients, although this decreased when the NNNS technique was used. Conclusions: This is the first report of the efficacy of the USG-NNNS technique for confirming the diagnosis of TTS.
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Ultrasound-guided release for iliotibial band syndrome: A novel ultraminimally invasive surgical procedure. Knee 2021; 30:9-17. [PMID: 33784536 DOI: 10.1016/j.knee.2021.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Iliotibial band (ITB) syndrome is the most common cause of lateral knee pain in runners (affecting 7-14%) and in persons taking part in other sports. The aim of this study was to show how to perform a distal release of the ITB guided by ultrasound and present our initial results with this new technique. METHODS The surgical technique - either Z-plasty or transverse section of the ITB - was first validated on 14 cadaver specimens and then applied in clinical practice. We operated on 32 patients (27 males and five females, 34 cases) from 2013 to 2018. Mean age was 40 years (25-60). The patients comprised 21 recreational middle- or long-distance runners (23 cases), five cyclists, two basketball players, two military personnel, one fireman, and one boxer. RESULTS All patients were satisfied after 3 months and returned to their sporting activities without restrictions. The visual analog scale score for the practice of sports activities improved from 7 (6-9) before surgery to 0 (0-1) after. The average Lysholm score was 68 points before surgery and 97 (91-100) after, with five good results and 29 excellent results. No patients complained of instability or muscle weakness after 3 months. CONCLUSION Ultrasound-guided release of the ITB is a novel minimally aggressive surgical approach that potentially enables faster recovery. It is relatively easy, quick, and painless, with a small incision, and can be performed under local anaesthesia in an outpatient setting. It does not require limb exsanguination or stitches, and complications are minimal.
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Villanueva M, Iborra Á, Sanz-Ruiz P, Noriega C. Ultrasound-guided surgery for lateral snapping hip: a novel ultraminimally invasive surgical technique. J Orthop Surg Res 2021; 16:322. [PMID: 34011357 PMCID: PMC8132356 DOI: 10.1186/s13018-021-02461-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. PURPOSE In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. METHODS The surgical technique-either z-plasty or transverse section of the ITB-was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 females) were operated from 2014 to 2018. Mean age was 43 years (29-62). RESULTS The snap resolved in all patients, as verified actively during the surgical procedure as the patient has only local anesthesia. The VAS score for sports activity improved from 7 (5-9) before surgery to 0 (0-2) after 1 year. The HSS score improved from 58 points (47-72) to 96 at 1-2 years. There were no complications other than minor hematomas nor recurrences. CONCLUSION Ultrasound-guided release of the LSH is a novel surgical option with encouraging results in patients for whom conservative protocols have failed. It can be performed under local anesthesia in an outpatient setting with minimal aggressiveness. It is relatively easy, quick, and painless; no stitches are required. Weight bearing is immediate, and patients usually need crutches for only 2-3 days. Although complete recovery may take 3 months, the rehabilitation protocol is fast and painless.
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Affiliation(s)
- Manuel Villanueva
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle de Donoso Cortes 80, 28015, Madrid, Spain.
| | - Álvaro Iborra
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle de Donoso Cortes 80, 28015, Madrid, Spain
| | - Pablo Sanz-Ruiz
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle de Donoso Cortes 80, 28015, Madrid, Spain
- Orthopaedic and Trauma Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Noriega
- Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle de Donoso Cortes 80, 28015, Madrid, Spain
- Department of Nursery and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Madrid, Spain
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Iborra A, Villanueva M, Sanz-Ruiz P, Martin A, Noriega C. A novel closed technique for ultrasound-guided plantar fascia release with a needle: review of 107 cases with a minimum follow-up of 24 months. J Orthop Surg Res 2021; 16:153. [PMID: 33627158 PMCID: PMC7903032 DOI: 10.1186/s13018-021-02302-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis. METHODS We performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia. The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7-66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27-72). Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index. RESULTS Heel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and dorsum of the foot, which improved with the use of plantar orthoses and a rehabilitation program. We recorded no nerve complications (e.g., paresthesia), vascular injuries, or wound-related problems. CONCLUSION Ultrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal. Stitches are not necessary, and recovery is fast. Consequently, costs are low, and the patient can return to work quickly. This technique may represent a valid option for treatment of plantar fasciitis.
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Affiliation(s)
- A. Iborra
- School of Health Sciences, Department of Podiatry, University of La Salle, Institute Avanfi, 28020 Madrid, Spain
| | | | - P. Sanz-Ruiz
- Institute Avanfi, 28020 Madrid, Spain
- Orthopaedic and Trauma Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Martin
- Institute Avanfi, 28020 Madrid, Spain
- Orthopaedic and Trauma Department, Hospital General Universitario Donostia, Madrid, Spain
| | - Concepción Noriega
- University of Alcalá, Madrid. School of Medicine and Health Sciences, Department of Nursery and Physiotherapy, University of Alcalá, Alcalá de Henares, Spain
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