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

BackgroundThe flexor hallucis longus (FHL) is a known site of pathological conditions. FHL stenosing tenosynovitis presents as posterior medial ankle pain or great toe discomfort and is often associated with a catching sensation of the great toe. There are a wide variety of open procedures for the treatment of FHL stenosing tenosynovitis.ObjectiveArthroscopic treatment may circumvent some of the complications associated with open surgical treatment of the hindfoot.MethodsArthroscopic surgery was completed in the supine position using modified posteromedial and posterolateral portals. A 70° arthroscope allowed for circumferential evaluation of the ankle through the posterolateral portal including the subtalar areas and the entire FHL tendon for release using basket forceps and a 3.5 mm shaver.ResultsThis method allows for decompression of the FHL from the entrance of the fibro-osseous tunnel to the knot of Henry. Active and passive range of motion of both the ankle and toes was encouraged postoperatively. The patient returned to sporting activity 6 weeks after surgery.ConclusionsEndoscopic treatment of the FHL stenosing tenosynovitis is presented as an alternative to an open surgical procedure; it may reduce wound complications and may allow for an earlier return to sport.