Name of the Procedure:

Capsulotomy, midfoot; medial release only (separate procedure)

Summary

A capsulotomy in the midfoot with medial release is a surgical procedure that involves cutting into the joint capsule on the inner side (medial side) of the midfoot to relieve stiffness, improve mobility, and alleviate pain.

Purpose

This procedure is generally performed to address conditions causing stiffness and restricted movement in the midfoot area, such as joint contractures or scarring. The primary goals are to increase joint mobility, reduce pain, and improve function.

Indications

• Persistent midfoot pain and stiffness not responding to conservative treatments
• Decreased range of motion in the midfoot
• Conditions like midfoot arthritis, capsulitis, or severe bunions where the joint capsule is constricted

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments or cessation of certain medications, especially blood thinners, may be necessary.
• Pre-operative imaging like X-rays or MRIs to assess the condition of the midfoot.

Procedure Description

1. Anesthesia: The patient is usually given local or general anesthesia depending on the complexity of the case.
2. Incision: A small incision is made on the medial (inner) side of the midfoot.
3. Capsulotomy: The surgeon cuts into the joint capsule to release tension and improve joint space.
4. Medial Release: Additional tissues causing stiffness or constriction are carefully released.
5. Closure: The incision is closed with sutures, and the area is bandaged.

Tools: Scalpel, retractors, sutures.

Duration

Approximately 1 to 2 hours, depending on the complexity.

Setting

Typically performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic or podiatric surgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Recurrence of stiffness or pain
• Poor wound healing

Benefits

• Improved range of motion in the midfoot
• Reduction of pain
• Enhanced functionality and ability to perform daily activities

Recovery

• Post-procedure instructions include wound care, limited weight-bearing on the affected foot, and possibly using crutches.
• A follow-up appointment is necessary to monitor healing.
• Physical therapy may be recommended.
• Recovery can take several weeks to months depending on the patient's overall health and adherence to post-operative care instructions.

Alternatives

• Non-surgical treatments like physical therapy, orthotics, or medications.
• Other surgical options such as more extensive reconstructive surgery.
• Each alternative has its own risks and benefits compared to a capsulotomy with medial release.

Patient Experience

• During the procedure, the patient will be under anesthesia and not feel pain.
• Post-procedure, there may be discomfort or pain, which is managed with prescribed pain medications.
• Limited mobility and the need to keep weight off the foot during the initial recovery period.
• Gradual return to normal activities as healing progresses.