Chapter 11 - Interventional Uses of Ultrasound in the Foot and Ankle

Needle is within the capsular space. Notice how the joint distracts as the fluid is injected into the joint.

The intervention is with PRP and the attempt is to address the hypoechoic areas within the tendon.

This procedure is performed mid arch. Through the same 5mm incision, first a hemostat is inserted freeing the subcutaneous layer and then the muscular layer. A 67 beaver blade is then introduced with the blade parallel and superficial to the ligament. The blade is then rotated 90 degrees so the cutting edge is on the surface of the ligament. With a gentle sawing action and the toes dorsiflexed by the assistant, the ligament is cut through violating the medial bands (due to the blades limited length). The assistant will be the first to recognize the procedure is completed, feeling the release and should relay that to the surgeon.

An excellent technique if there are blood vessels superficial to the nerve and there is enough room for probe and needle placement.

Initially the probe is short axis to the tendon, with the needle out of plane. Subsequently, the probe is orientated long axis with the needle staying in place which now has an in-plane orienta-tion with the probe.