Table 1.

Pearls and Pitfalls of Endoscopic Loose Body Removal From Zone 2 FHL Tendon Sheath

Pearls

The ankle is positioned in slight plantar flexion during zone 2 FHL tendoscopy to reduce the risk of injury to the neurovascular bundle at the tarsal tunnel.

The plantar portal is made slightly distal to the navicular to allow access to the master knot of Henry.

Synovectomy and removal of loose bodies should be avoided in zone 2B.

Complete synovectomy should be performed in zone 2A.

Small loose bodies are grasped and removed through the plantar portal.

Large loose bodies are pushed proximally to the retrocalcaneal space and removed by zone 1 FHL tendoscopy.

Pitfalls

The tibial neurovascular bundle (especially the fibers of the lateral plantar nerve) at the tarsal tunnel can be compressed by the shaft of the arthroscope during zone 2 FHL tendoscopy.

The medial plantar nerve can be injured by the Wissinger rod when it passes through the sole.

The medial plantar nerve can be injured during instrumentation in the zone 2B fascial tendon sheath.

FHL, flexor hallucis longus.