Name of the Procedure:

Capsulotomy, midtarsal (Heyman type procedure)

Summary

A Capsulotomy, midtarsal (Heyman type procedure) is a surgical intervention that involves making an incision in the joint capsule of the midtarsal area of the foot. This procedure helps to correct structural deformities and alleviate pain.

Purpose

The primary purpose is to correct deformities in the midtarsal joint, which can cause pain and impaired movement. The goal is to realign the foot's structure, relieve pain, and restore normal function and mobility.

Indications

• Severe pain in the midtarsal joint that does not respond to conservative treatments.
• Structural deformities such as flatfoot or cavus foot.
• Chronic instability or subluxation of the midtarsal joint.

Preparation

• Pre-procedure fasting for at least 8 hours.
• Adjustment of medications, especially blood thinners.
• Diagnostic imaging tests like X-rays or MRIs may be required to assess the extent of the deformity.

Procedure Description

1. The patient is administered anesthesia, commonly regional or general.
2. An incision is made over the midtarsal joint.
3. The joint capsule is carefully cut to access the joint structures.
4. Necessary corrections are made to the bone and soft tissues to realign the joint.
5. The incision is closed with sutures.
6. The foot is typically immobilized using a splint or cast.

Equipment used may include surgical knives, retractors, and alignment tools.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital or surgical center's operating room.

Personnel

• Orthopedic surgeon or podiatric surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Nerve damage leading to numbness or weakness
• Incomplete correction of deformity
• Joint stiffness or arthritis development

Benefits

Patients can expect reduced pain, improved foot alignment, and restored function, often realizing benefits within a few months post-surgery.

Recovery

• The foot is typically immobilized for several weeks.
• Patients will need to elevate and ice the foot to reduce swelling.
• Pain management may include medications or ice packs.
• Physical therapy may be necessary for full recovery.
• Full recovery typically takes 6 to 12 weeks, with follow-up appointments to monitor progress.

Alternatives

• Orthotic devices or corrective footwear
• Physical therapy to strengthen muscles around the joint
• Non-surgical interventions such as anti-inflammatory medications or injections Each alternative has its own set of advantages and limitations compared to the surgical option.

Patient Experience

During the procedure, patients will be under anesthesia and should feel no pain. Post-procedure, there may be discomfort and swelling, managed with pain relief measures. Patients should be prepared for a period of limited mobility and gradual rehabilitation.