Emphasizing The Minimally Invasive Benefits Of The KobyGard System

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When performing a minimally invasive plantar fasciotomy, one would make a 1 cm vertical incision at the junction of the medial and plantar skin lines.
For a minimally invasive Morton’s neuroma decompression, incise the toe sulcus in the desired interspace with a 1 cm vertical incision.
Insert the blade into the back of the instrument and transect the ligament until there is no more resistance.
For a gastroc recession, one would palpate the medial side of the proximal portion of the tendo-Achilles until you can feel the soleus muscle.
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Author(s): 
By Richard O. Lundeen, DPM

Key Pearls For Performing Different Procedures

   Minimally invasive plantar fasciotomy (MIPF). When performing a minimally invasive plantar fasciotomy, one would make a 1 cm vertical incision at the junction of the medial and plantar skin lines. Make the incision by palpating that area about 1 cm distal to the medial tubercle of the calcaneus. Deepen it by blunt dissection and insert the fascial elevator perpendicular to the long axis of the foot. Make a channel above and below the plantar fascia.

   Then proceed to insert the fascial separator in the channel to prepare the soft tissue for the Koby instrument. Once the separator is in place, place the instrument in the incision, insert the KobyGard blade into the instrument and pass it back and forth several times until you have released the fascia. Remove the instrument and use the fascial elevator to palpate the fascia to ensure an adequate release. By reinserting the KobyGard instrument, one can release additional fascia until you have achieved the desired amount of release.

   Minimally invasive Morton’s neuroma decompression (MIND). One may use a minimally invasive Morton’s neuroma decompression for intermetatarsal ligament release. To do so, one would incise the toe sulcus in the desired interspace with a 1 cm vertical incision. Deepen the incision by blunt dissection, insert the fascial elevator and make a channel above and below the intermetatarsal ligament. Place the ligament separator in the channel to prepare the site for the KobyGard instrument. After removing the separator, insert the instrument. One would insert the blade into the back of the instrument and transect the ligament until there is no more resistance.

   Subsequently, the surgeon should remove the instrument and blade, and use the fascial elevator to probe the site to ensure a complete release. If a portion of the ligament remains, one should reinsert the KobyGard and use the blade to complete the release.

   Gastroc recession. Palpate the medial side of the proximal portion of the tendo-Achilles until one can feel the soleus muscle. Just above the juncture, make a 1 cm vertical incision. Bluntly dissect the wound until you are able to introduce the fascial elevator and make a channel in front of and behind the gastroc tendon. Then place the KobyGard instrument in the channel. With the foot dorsiflexed, insert the blade into the instrument and release the tendon.

   Often one will not attain a complete release on the first pass-through and must reintroduce the instrument and blade to complete the recession. The surgeon should only release enough to maintain the foot in a 90-degree angle to the leg.

Final Words

   Using the KobyGard system to facilitate percutaneous treatment with these three procedures has proven to be reliable, quick and relatively free of complications. An added benefit is that these surgeries do not have a long learning curve when it comes to mastering the techniques.

   Dr. Lundeen is the Residency Director of the Winona Hospital Podiatric Residency Program in Indianapolis.

   Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons and is board certified in foot and ankle surgery. Dr. Burks practices in Little Rock, Ark.




References:

1. OsteoMed, Addison, Texas.
2. Instratek Incorporated, Spring, Texas.

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