What is Tendoscopy?
Tendoscopy is a minimally invasive surgical procedure that enables your orthopedic surgeon to view the tendon from within its sheath to evaluate and treat tendon problems in the foot and ankle. Tendoscopy is similar to arthroscopy in which a flexible fibreoptic instrument with a light and video camera on the end and special instruments are inserted through small incisions along the tendon. The main objective of tendoscopy is to treat conditions of the tendon without using larger incisions as in traditional open surgery. Some of the benefits of tendoscopy of the foot and ankle over standard open surgery include:
- Smaller incisions
- Minimal pain
- Minimal bleeding
- Minimal scarring
- Minimal risk of infection
- Faster recovery
- Early mobilization
Indications for Tendoscopy
Your surgeon may recommend tendoscopy if non-surgical treatment such as medications and physical therapy have failed to provide satisfactory results in the treatment of tendon conditions of the foot and ankle. Tendoscopy can be considered for managing foot and ankle tendon conditions, such as:
- Synovitis or inflammation of the tendon sheath that happens as a result of overuse, injury, connective tissue disease, or abnormal biomechanics.
- Partial ruptures of the tendon that can happen through chronic repetitive stress or injury.
- Adhesions of the tendon to its sheath or surrounding covering.
- Removal of small bone spurs that may be irritating or impinging a tendon.
- The release of the tendon that is tethered and unable to move in its sheath.
- Biopsy of the tendon sheath to assist with diagnosing an inflammatory condition.
Preparation for Tendoscopy
Preparation for tendoscopy may involve the following steps:
- A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to the surgery.
- You may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the surgery.
- You should inform your doctor if you have allergies to medications, anesthesia, or latex.
- You should also inform of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to refrain from certain medications such as blood thinners, anti-inflammatories, or supplements for a week or two prior to the surgery.
- You should refrain from alcohol or tobacco at least a few days before surgery and several weeks after, as it can hinder the healing process.
- You should arrange for a family member or a friend to drive you home after the surgery.
- A signed informed consent will be obtained from you after the surgery has been explained in detail.
Procedure for Tendoscopy
The minimally invasive tendoscopy procedure is usually performed as an outpatient procedure, meaning you can go home the same day of the treatment. In general, tendoscopy will involve the following steps:
- You will be placed in a supine (face-up) position on the procedure table with your foot held in an optimal position to facilitate surgery.
- You may be put under general anesthesia or milder forms of anesthesia such as sedation or nerve block.
- Two small surgical incisions called portals are made around the affected tendon.
- A scope will be inserted through one of the portals into the tendon sheath.
- Along with the scope, a sterile solution is pumped into the tendon sheath to expand it and enable your surgeon to have a clear view and space to work inside the affected area.
- Specialized miniature instruments are then introduced through the other portal and the required repair is performed as per the prevailing tendon condition.
- The instrument most commonly employed in a tendoscopy procedure is called a shaver, which is utilized to clean and suction out the build-up of scar tissue, loose cartilaginous fragments, and/or overgrowth of unwanted tissue that is impinging and causing pain in the foot and ankle.
- Once the procedure is complete, your surgeon will close the skin portals with sutures, apply a sterile dressing, and place your foot in an orthopedic boot or splint.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after tendoscopy will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover from the effects of the anesthesia.
- Following surgery, assistive devices such as an orthopedic boot or splint will be applied for protection of the treatment area and to facilitate healing, along with instructions on restricted weight-bearing.
- You may notice some pain, swelling, and discomfort in the foot area. Pain and anti-inflammatory medications are provided as needed to address these. You may also apply ice packs for comfort.
- You are advised to keep your foot elevated as much as possible while resting to reduce swelling and pain.
- Instructions on surgical site care and bathing will be provided to keep the surgical site clean and dry.
- Refrain from strenuous activities such as running for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol will be recommended to help strengthen foot muscles and optimize foot function.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- You will be discharged home with a cane, walker, or crutches to facilitate safe walking. Most patients are able to resume their normal activities in a month’s time. Return to sports may take at least 6 months or longer.
- Periodic follow-up appointments will be scheduled to monitor your progress.
Risks and Complications
Tendoscopy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Pain and discomfort
- Adverse reactions to anesthesia
- Thromboembolism or blood clots
- Damage to surrounding soft tissue structures such as nerves and blood vessels