Arthroscopic release of flexor hallucis longus tendon using modified posteromedial and posterolateral portals in the supine position

Endoscopic treatment of trigger toe

“…A escala visual ana lógica de dor (EVA) e o questionário American Orthopaedic Foot and Ankle Society (AOFAS) foram usados para avaliar os resultados no pré e pósoperatório, sendo que a paciente obteve no EVA 7 pontos no préoperatório e 1 ponto no pósoperatório e no AOFAS 77 pontos no préoperatório e 100 pontos no pósoperatório. (8) relataram a liberação endoscópica de uma tenossinovite estenosante do tendão FLH. Entretanto, em ambos os trabalhos nenhum dos pa cientes apresentava o engatilhamento do hálux.…”

Disorders of the Flexor Hallucis Longus and Os Trigonum

“…The tendon then runs underneath the intersesamoid ligament and inserts at the plantar surface of the distal phalanx of the great toe. 45,46 The blood supply to the FHL arises from the posterior tibial and medial plantar arteries, whereas the tibial nerve provides innervation to the muscle. 37 The primary function of the FHL is as an active plantarflexor at the first metatarsophalangeal (MTP) and hallux interphalangeal joints and as the primary restraint to passive dorsiflexion at the first MTP joint.…”

“…37 Impingement can occur at the flexor sheath posterior to medial malleolus, the entrance to the fibro-osseous tunnel, the knot of Henry, and the intersesamoid ligament. 46 When significant nodular change or hypertrophy appears in the FHL tendon, the excursion can be limited because of these 3 restriction points and may causes triggering or limitation of motion of the great toe. 22,37,49 However, when nodularity or hypertrophy part is moved proximal to the restricted fibro-osseous area by maximum plantar flexion of the ankle, dorsiflexion of the first MTP joint is restored, the socalled pseudo-hallux rigidus.…”

“…53 In FHL tenosynovitis, patients may report discomfort on the great toe 46 as well as at the posteromedial (PM) ankle; however, patients can present with plantar heel pain, plantar midfoot pain, pain at the first MTP joint, or multiple locations of pain. 21,22,37,40 Some patients may be presented with stiffness of the first MTP joint particularly in dorsiflexion, and some individuals may notice a crackling or squeaking sound.…”

“…Average time to return to activities is 12 to 25 weeks 18,35,40 in the open approach and 6 to 8 weeks in the arthroscopic approach. 46,60 …”