Wake Jeffrey, Martin Kevin
Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, U.S.A.
Evans Army Community Hospital, Fort Carson, Colorado, U.S.A.
Arthrosc Tech. 2017 Oct 30;6(5):e2019-e2022. doi: 10.1016/j.eats.2017.07.023. eCollection 2017 Oct.
Adult acquired flatfoot deformity (AAFD), formerly known as posterior tibial tendon (PTT) dysfunction, is one of the most common problems of the foot and ankle. It was first described as tendon failure but has since been revealed as ligamentous failure in addition. AAFD is a spectrum of deformities that ranges from tenosynovitis (stage I) to AAFD (stages II-IV). Regarding mild stage I and stage II disease, it was once standard to perform an open synovectomy completely removing the inflamed synovium; this procedure required a large 6-cm medial ankle incision. Postoperative management included plaster cast immobilization for 3 weeks, followed by a boot with controlled ankle movement for another 3 weeks. Now, the standard is shifting to PTT endoscopy, which has proved to be an efficient way to treat tenosynovitis in stage I and II AAFD with a shorter postoperative period. Using this technique, we can achieve 360° visualization of the PTT within the tendon sheath, allowing for a complete exploration and debridement. We hope that by using this video description, practitioners could avoid the increased morbidity associated with open procedures, as well as help patients return to activity sooner after surgery.
成人获得性平足畸形（AAFD），以前称为胫后肌腱（PTT）功能障碍，是足踝部最常见的问题之一。它最初被描述为肌腱功能衰竭，但后来也被发现存在韧带功能衰竭。AAFD是一系列畸形，范围从腱鞘炎（I期）到AAFD（II-IV期）。对于轻度的I期和II期疾病，曾经的标准治疗方法是进行开放性滑膜切除术，完全切除发炎的滑膜；该手术需要在踝关节内侧做一个6厘米的大切口。术后处理包括用石膏固定3周，然后再用可控制踝关节活动的靴子固定3周。现在，标准正在转向PTT内镜检查，事实证明这是治疗I期和II期AAFD腱鞘炎的一种有效方法，术后恢复时间更短。使用这种技术，我们可以在腱鞘内实现对PTT的360°可视化，从而进行全面的探查和清创。我们希望通过这段视频描述，从业者能够避免开放性手术带来的更高发病率，同时帮助患者术后更快恢复活动。
