Name of the Procedure:

Tenotomy, Lengthening, or Release, Abductor Hallucis Muscle

Summary

This procedure involves surgically lengthening, releasing, or cutting the abductor hallucis muscle, which is located in the foot. It aims to alleviate pain or correct deformities associated with conditions affecting the muscle.

Purpose

The primary goal is to relieve discomfort and improve function in the foot due to conditions like bunions, hammertoes, or flat feet. By addressing tightness or spasms in the abductor hallucis muscle, the procedure helps in restoring normal foot mechanics and reducing pain.

Indications

• Presence of bunions or hallux valgus
• Hammertoe deformities
• Plantar fasciitis
• Overpronation or flat feet causing functional impairment
• Persistent pain or spasms in the abductor hallucis muscle unresponsive to conservative treatments

Preparation

• Patients may need to fast for several hours before the procedure.
• Pre-operative assessment includes a thorough medical history, physical examination, and imaging studies like X-rays or MRI.
• Adjustments to current medications may be required, especially if the patient is on blood thinners or anticoagulants.

Procedure Description

1. The patient is positioned, and the operative site is sterilized.
2. Local or general anesthesia is administered based on patient and surgeon preferences.
3. A small incision is made along the foot to access the abductor hallucis muscle.
4. The surgeon then cuts, lengthens, or releases the muscle to achieve the desired effect.
5. The incision is closed with sutures, and a sterile dressing is applied.

Tools used include scalpels, surgical scissors, and suturing materials.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

It is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Orthopedic surgeon or podiatric surgeon
• Anesthesiologist or nurse anesthetist (if general anesthesia is used)
• Surgical nurses and assistants

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Neurological injury resulting in numbness or weakness
• Excessive lengthening causing muscle weakness
• Scar tissue formation leading to stiffness

Benefits

• Alleviation of pain and muscle spasms
• Improved foot function and alignment
• Enhanced mobility and quality of life Most benefits are typically realized within a few weeks to months, depending on the patient's recovery.

Recovery

• Patients are advised to keep the foot elevated and avoid weight-bearing activities initially.
• Pain management includes prescribed medications and ice applications.
• Follow-up appointments are crucial for dressing changes and monitoring recovery.
• Physical therapy may be recommended to restore strength and mobility.
• Estimated full recovery time is between 6 to 12 weeks, with gradual resumption of normal activities.

Alternatives

• Conservative treatments like physical therapy, orthotics, and anti-inflammatory medications.
• Other surgical options depending on the condition, such as bunionectomy or tendon transfer. Alternative treatments focus on different mechanisms and have varied recovery times and success rates.

Patient Experience

During the procedure, patients will be under anesthesia and should not feel pain. Post-operatively, some discomfort and swelling are expected, typically managed with medications. Patients should anticipate a period of limited mobility and the need for supportive care during recovery.