Table 3.

Step-by-Step Guide to Performing In-Office Tibialis Posterior Tendoscopy

Step 1: Position the patient in lateral decubitus on an examination table to make the medial aspect of the operative ankle easily accessible.

Step 2: Use a chlorhexidine gluconate/isopropyl alcohol sponge-stick to sterilely prepare the ankle.

Step 3: Drape the ankle to create a sterile field along the distal half of the examination table.

Step 4: Inject local anesthesia superficially into the anticipated portals and deep along the tibialis posterior tendon.

Step 5: Establish portals with a superficial stab incision followed by blunt dissection. Start with the retromalleolar portal and finish with the more proximal portal under direct visualization.

Step 6: Carefully debride fatty tissue around the tendon to allow for full visualization.

Step 7: Perform a diagnostic tendoscopy along the length of the tendon from just inferior to the medial malleolus up to the myotendinous junction.

Step 8: Treat the tibialis posterior tendon as necessary. This step may include tenosynovectomy, debridement of frayed tissue, removal of adhesions, or shaving of the retromalleolar bone to produce local bleeding.

Step 9: Ask the patient to actively range their ankle to assess tendon function.

Step 10: Perform wound closure with steri-strips and apply soft dressing or splint as indicated.