How you do your TALs

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How do you do your TALs? Open, percutaneous, or referral 🙂D)?

 

[Podfather]

How do you do your TALs? Open, percutaneous, or referral 🙂D)?

For an adjunct to flat foot reconstruction I will do a percutaneous one the majority of the time. For equinus deformities ( toe walkers, as an adjunct to drop foot repairs with TP tendon transfer) open often with ankle/STJ release, possibly syndesmotic release. Refer? Ha you can send yours to me

 

[krabmas]

How do you do your TALs? Open, percutaneous, or referral 🙂D)?

1st I hope we are saying that they need a TAL vs a Gastroc determined by silfverskiold exam.

In diabetics for forefoot ulcers or TMAs - perqutaneous TAL w/ 3 hemisections most distally lateral, then medial, then most proximal lateral. This is the Dr. Steinberg method since the sural nerve most likely at this point is useless, but the PT artery may be the only vessel supplying the foot.

In non-diabetic adult that needs a TAL - perQ medial, lateral, medial to spare the sural nerve

In children - open, white procedure (uses the twist of the fibers for the plane of lengthening)

I think you have to be very careful about doing TALs in adults for flatfoot. It significantly weakens the tendon and most (not all, but most) adults with flatfoot (PTTD) have a gastroc equinus and need only a gastroc recession and not a full TAL.

 

[347932]

Percutaneous for me.

If they need a gatroc recession than open V type.

Big thing now is the arthroscopic release, but the more I read, the more incidents of nerve entrapment I find. No thanks.

 

[krabmas]

Percutaneous for me.

If they need a gatroc recession than open V type.

Big thing now is the arthroscopic release, but the more I read, the more incidents of nerve entrapment I find. No thanks.

what joint do you release the tendon in?

 

[347932]

what joint do you release the tendon in?

I'm sorry, I mispoke. I meant endoscopic, not arthroscopic. My bad and apologies.

 

[krabmas]

I'm sorry, I mispoke. I meant endoscopic, not arthroscopic. My bad and apologies.

No problem, just a little pet peeve of mine.

I've done one endoscopic gastroc and was so unsure if the whole thing was released, never saw the nerve... too nerve recking, and not a time saver.

Many hand surgeons are not doing endoscopic carpal tunnel releases due to possible pinching of the median nerve by the scope during insertion.

It's all great until the patient wakes up.