Name of the Procedure:

Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot deformity)

Summary

Capsulotomy is a surgical procedure where the joint capsule surrounding the midfoot is incised to release tight or contracted soft tissues. This extensive procedure often includes posterior talotibial capsulotomy and the lengthening of tendons, commonly performed to correct resistant clubfoot deformities.

Purpose

The procedure addresses severe and resistant clubfoot deformities, which are characterized by a twisted or misshapen foot due to congenital conditions. The goal is to correct the deformity, improve foot alignment, and enhance mobility and function.

Indications

• Severe, resistant clubfoot deformity that has not responded to non-surgical treatments.
• Significant restriction of foot movement due to tight or contracted joint capsule and tendons.
• Difficulty in walking or abnormal gait due to foot deformity.
• Patients for whom alternative conservative treatments (e.g., bracing, physical therapy) have failed.

Preparation

• Patients may need to fast for several hours before the procedure.
• Pre-operative diagnostic tests, including X-rays or MRI, may be required to assess the extent of the deformity.
• Medication adjustments and cessation of certain drugs, as advised by the surgeon.
• Pre-surgical consultations to review medical history and anesthesia requirements.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made over the affected area of the midfoot.
3. The joint capsule is carefully incised and released.
4. The posterior talotibial capsule is specifically addressed to correct deformities.
5. Tendons may be lengthened to decrease tension and allow for proper foot alignment.
6. The surgeon assesses and adjusts the foot position to ensure proper alignment.
7. The incision is closed with sutures, and a cast or brace is applied to maintain the corrected position.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity of the deformity and the extent of the surgery.

Setting

Capsulotomy procedures are usually performed in a hospital or surgical center, in an operating room setting.

Personnel

• Orthopedic surgeon or pediatric orthopedic surgeon specializing in foot deformities.
• Anesthesiologist or nurse anesthetist for administering anesthesia.
• Surgical nurses and assistants to support the procedure.

Risks and Complications

• Common risks: Infection, bleeding, and swelling at the surgical site.
• Rare risks: Nerve damage, blood vessel injury, improper healing, and recurrence of deformity.
• Potential complications: Delayed wound healing, adverse reactions to anesthesia, and difficulty in pain management.

Benefits

• Improved foot alignment and appearance.
• Enhanced mobility and functional ability.
• Relief from pain and discomfort associated with the deformity.
• Increased quality of life and ease of walking.

Recovery

• Post-operative care includes keeping the cast clean and dry, monitoring for signs of infection, and taking prescribed medications.
• Follow-up appointments for cast removal and progress assessment.
• Physical therapy may be required to regain strength and range of motion.
• Recovery can take several weeks to months, with gradual return to normal activities.

Alternatives

• Non-surgical treatments like braces, orthotics, and physical therapy.
• Other surgical procedures such as tendon transfers and osteotomies.
• Pros and cons: Non-surgical options have longer treatment times and may not be effective for severe deformities, whereas surgical alternatives may involve different risks and recovery profiles.

Patient Experience

• During the procedure: The patient will be under general anesthesia, so they will not feel any pain.
• After the procedure: Pain management with medications, possible swelling, and discomfort.
• Comfort measures: Elevation of the foot, ice packs, and prescribed pain relief medications to manage post-operative pain and swelling.