plantar fasciectomy

The aponeurosis is located on the sole of the foot, the posterior side is narrow, attached to the calcaneal nodule; it is enlarged forward, and is divided into five branches at the humeral head, which are respectively fused with the soft tissue of the flexor tendon fibrous sheath and the metatarsophalangeal joint of the respective toes. The diaphragm is divided into three parts, the inner and outer sides are weak, and the middle part is thick; the two parts are separated into two parts, and the foot is divided into three gaps. The aponeurosis is like a bowstring on the sole of the foot, which maintains the arch of the foot while protecting the deep blood vessels and nerves. At present, when the foot is flexed and the arch of the foot becomes short, the sacral membrane becomes shorter and shorter. Because of its strong and powerful, aponeurosis is needed to correct the deformity. The main function of the operation is to relax the bowstring to straighten the arch back, and then correct the high bow deformity; but this is only an auxiliary surgery, and should be combined with other orthopedic surgery to better correct the deformity of the foot. Treatment of diseases: congenital high arch foot congenital clubfoot Indication 1. Congenital palpebral varus in children over 2 years of age without satisfactory treatment, and children with residual high bow or deformity after non-surgical treatment, suitable for decidual surgery. 2. High arch foot caused by various reasons, aponeurosis can be used as an auxiliary surgery. Preoperative preparation 1. Pre-operative regular skin preparation for 3 days. 2. For those with skin palsy, it should be softened and cleaned with warm water 1 week before surgery to facilitate surgery. 3. Preoperative examination of the deformity of the foot and its causes (such as muscle contracture or paralysis, soft tissue contracture, etc.), and then design surgery according to the situation, in order to obtain satisfactory results. Surgical procedure 1. Position: supine position, the limbs are 45° high. 2. Incision: 1~1.5cm under the medial malleolus, at the junction of red and white meat on the medial edge of the calcaneus, a short curved incision, about 3cm long. The front end of the incision should be avoided over the lower end of the medial malleolus to avoid damage to the motion, veins and nerves on the medial side of the plantar. 3. Reveal the aponeurosis: use the small four-claw hook to pull the cutting edge apart, and make a blunt separation under the skin to reach the tough and elastic inner edge of the aponeurosis; in the deep part, the abductor toe muscle. 4. Peeling the aponeurosis: peeling the fibrous adipose tissue on the tarsal surface with a periosteal stripper at the calcaneus nodule, and then pulling the subcutaneous tissue and skin with a small hook to make the aponeurosis attached to the calcaneus The full width is fully revealed. 5. Cut off the aponeurosis and correct the deformity: The sputum assistant will force the back of the foot to make the aponeurosis tense. The surgeon cuts the diaphragm with a sharp-edged knife at the attachment of the calcaneal nodule, and uses the periosteal stripper to peel the diaphragm and the temporal muscle from the calcaneal nodule and push it toward the front side of the foot. At the same time, the extension of the forefoot assisted release, and the high bow deformity can be corrected. However, it is necessary to pay attention to not to damage the calcaneus when peeling, so as to avoid bone hyperplasia and cause pain in the future. 6. Suture, external fixation: general intraoperative bleeding is not much. The wound is sutured after hemostasis and fixed with short leg or long leg plaster boots. The plaster boots must be well shaped to maintain the position after the high bow is corrected, otherwise the deformity will remain.