Arthroscopic Resection of Too-Long Anterior Process (TLAP) of the Calcaneus, Anterior Subtalar Synovectomy, Debridement of the Sinus Tarsi, and Posterior Subtalar Adhesiolysis Via Anterolateral Subtalar and Dorsolateral Midtarsal Portals

Lateral heel pain can have numerous causes and many of them are intra-articular pathologies of the anterior and posterior subtalar joint. Frequently, there is not a single pathology that account for the lateral heel pain and combination of different pathologies can occur. Symptomatic too-long anterior process of the calcaneus, sinus tarsi syndrome, and subtalar arthrofibrosis can be precipitated by repeated sprain. Cases recalcitrant to conservative treatment are indicated for surgery. The purpose of this Technical Note is to report a 2-portal arthroscopic approach to address these pathologies.
Technique Video Video 1 Arthroscopic resection of too-long anterior process (TLAP) of the calcaneus, anterior subtalar synovectomy, debridement of the sinus tarsi, and posterior subtalar adhesiolysis of the left foot via anterolateral subtalar and dorsolateral midtarsal portals. The patient is in the lateral position. The anterolateral subtalar portal is the viewing portal and dorsolateral midtarsal portal is the working portal. Anterior subtalar synovectomy is performed. The anterior subtalar joint is traced distally to the TLAP lesion, which is then resected with an arthroscopic acromionizer. The arthroscope is switched to the dorsolateral midtarsal portal and the sinus tarsi is debrided with the arthroscopic shaver via the anterolateral midtarsal portal. The fibrotic posterior subtalar capsule is then resected followed by synovectomy. The fibrous tissue of the lateral and anterior recesses of the posterior subtalar joint is resected. The fibrous tissue between the articular surfaces is loosened with an arthroscopic probe and then resected with the shaver. Finally, the fibrous tissue of the posterior gutter is resected.