PMC6594286_01
Patient II: the STA was debrided with the removal of its muscle belly, preserving the total length of the tendon.
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fig2
The illustrative case (patient II) was presented for the demonstration of the surgical technique (Figures 2-9). We kept the STA in its full length to ensure that the entire defect was filled after the resection of the unhealthy PB tendon (Figure 2).
Patient II: the lateral approach is a curved incision starting 3-4 cm above the tip of the lateral malleolus, extending over the course of the PT to the base of the fifth metatarsal.
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fig3
The illustrative case (patient II) was presented for the demonstration of the surgical technique (Figures 2-9). A lateral curved incision over the course of the PT was performed along the posterior border of the lateral malleolus, from 3 to 4 cm proximal to the tip of the fibula extending to the fifth metatarsal base (Figure 3).
Patient II: extensive alteration of the PB tendon.
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fig4
The illustrative case (patient II) was presented for the demonstration of the surgical technique (Figures 2-9). Dissection was performed proximally and extended distally to isolate the compromised portion of the tendon (Figure 4).
Patient II: the STA is secured to the proximal stump of the PB tendon with a Pulvertaft weave using a 1-0 Vicryl, 3 cm proximal to the tip of the lateral malleolus.
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fig5
The illustrative case (patient II) was presented for the demonstration of the surgical technique (Figures 2-9). The STA was sutured to the proximal stump of the native PB tendon using a Pulvertaft suture with a 1-0 Vicryl (Figure 5).
Patient II: aspect of the STA after proximal fixation. We have used the STA in its full length to ensure that there was adequate distal stump length remaining to fix it to the base of the fifth metatarsal.
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fig6
The illustrative case (patient II) was presented for the demonstration of the surgical technique (Figures 2-9). STA was carried out through a bone tunnel at the fifth metatarsal base to provide a bone-to-tendon fixation. Since we kept the full length of the STA, there was an adequate distal stump length remaining to fix it distally (Figure 6).
Patient II: the bone tunnel is drilled for a bone-to-tendon fixation with a 3.2 mm drill at the base of the fifth metatarsal perpendicular to the bone, from plantar to dorsal.
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fig7
The illustrative case (patient II) was presented for the demonstration of the surgical technique (Figures 2-9). The bone tunnel was drilled with a 3.2 mm drill (Figure 7) perpendicular to the long axis of the fifth metatarsal, from plantar to dorsal.
Patient II: bone-to-tendon fixation distal through the bone tunnel after the removal of the remaining portion of the STA.
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fig8
The illustrative case (patient II) was presented for the demonstration of the surgical technique (Figures 2-9). The distal stump was pulled from plantar to dorsal through the tunnel and sutured back to itself with a 1-0 Vicryl (Figure 8).
Patient II: (a) single-heel rise test and (b) inversion range of motion at 6 months after surgery.
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fig9
The illustrative case (patient II) was presented for the demonstration of the surgical technique (Figures 2-9).