Surgical treatment of stenosing tenosynovitis at the ankle.

Twelve cases of stenosing tenosynovitis about the ankle (eight posterior tibial and four peroneal), with at least 2 to 4 years of follow-up, have been successfully relieved of their symptoms and returned to increased activity by utilizing a simplified comprehensive surgical technique. Surgery consists of: 1) appropriate treatment to the tendon itself whether intact, partially ruptured, or completely ruptured; 2) deepening of the constricted groove; 3) fashioning of new pulleys from available sheath and retinaculum; and 4) construction of a new sheath from regional deep fascia. Postoperative management includes non-weightbearing, soft bandages, and home exercise therapy for 1 month, followed thereafter by intensive home therapy buildup of the involved muscle and orthoses. Pathology findings included thickening of the tendon sheath, varying degrees of fibrosis of the tendon itself, with or without rupture, and reactive hypertrophy of the bone at the involved groove.