Patent Publication Number: US-2017354433-A1

Title: Device for plantar fascia endoscopy and soft tissue releases

Description:
RELATED APPLICATIONS 
     The present application claims the benefit of U.S. Provisional Application Ser. No. 62/349,963, filed Jun. 14, 2016, which is herein incorporated by reference in its entirety. 
    
    
     THE FIELD OF THE INVENTION 
     The present invention relates to soft tissue releases. In particular, examples of the present invention relate to a device and related method for plantar fascia endoscopy and soft tissue releases. 
     BACKGROUND 
     Some conditions, such as plantar fasciitis, may require a soft tissue release for treatment. Plantar fasciitis involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of the foot and connects the heel bone to the toes. For many individuals, plantar fasciitis may be treated conservatively with anti-inflammatory drugs and stretching and strengthening exercises. Where conservative treatment does not resolve the plantar fasciitis, surgical treatment may be necessary. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Non-limiting and non-exhaustive examples of the present invention are described with reference to the following figures, wherein like reference numerals refer to like parts throughout the various views unless otherwise specified. 
         FIG. 1A  shows a drawing overview of a method and system for treatment of plantar fasciitis using a clamping arthroscopic resection tool. 
         FIG. 1B  shows a drawing overview of a method and system for treatment of plantar fasciitis using a clamping arthroscopic resection tool. 
         FIG. 1C  shows a drawing overview of a method and system for treatment of plantar fasciitis using a clamping arthroscopic resection tool. 
         FIG. 2  shows a side view of an embodiment of the clamping arthroscopic resection tool. 
         FIG. 3  shows a perspective view of an embodiment of the clamping arthroscopic resection tool. 
         FIG. 4A  shows a bottom view of an embodiment of the clamping arthroscopic resection tool. 
         FIG. 4B  shows a top view of an embodiment of the clamping arthroscopic resection tool. 
         FIG. 5  shows a disassembled perspective view of an embodiment of the clamping arthroscopic resection tool. 
         FIG. 6A  shows a drawing of the clamping arthroscopic resection tool used during surgery. 
         FIG. 6B  shows a drawing of the clamping arthroscopic resection tool used during surgery. 
         FIG. 6C  shows a drawing of the clamping arthroscopic resection tool used during surgery. 
         FIG. 6D  shows a drawing of the clamping arthroscopic resection tool used during surgery. 
         FIG. 6E  shows a drawing of the clamping arthroscopic resection tool used during surgery. 
         FIG. 7A  shows a bottom view drawing of the second body member of the clamping arthroscopic resection tool. 
         FIG. 7B  shows a side view drawing of the second body member of the clamping arthroscopic resection tool. 
         FIG. 7C  shows a top view drawing of the second body member of the clamping arthroscopic resection tool. 
         FIG. 8A  shows a bottom view drawing of the first body member of the clamping arthroscopic resection tool. 
         FIG. 8B  shows a side view drawing of the first body member of the clamping arthroscopic resection tool. 
         FIG. 8C  shows a top view drawing of the first body member of the clamping arthroscopic resection tool. 
         FIG. 9A  shows a side view drawing of the third body member, the cutting member, of the clamping arthroscopic resection tool. 
         FIG. 9B  shows a bottom view drawing of the third body member, the cutting member, of the clamping arthroscopic resection tool. 
         FIG. 10  shows a side view of a disposable clamping arthroscopic resection tool. 
         FIG. 11  shows a perspective view of a disposable clamping arthroscopic resection tool. 
         FIG. 12  shows a perspective view of a portion of a disposable clamping arthroscopic resection tool. 
         FIG. 13A  shows a top view of a disposable clamping arthroscopic resection tool. 
         FIG. 13B  shows a bottom view of a disposable clamping arthroscopic resection tool. 
         FIG. 14  shows a disassembled perspective view of a disposable clamping arthroscopic resection tool. 
         FIG. 15A  shows a drawing of the disposable clamping arthroscopic resection tool used during surgery. 
         FIG. 15B  shows a drawing of the disposable clamping arthroscopic resection tool used during surgery. 
         FIG. 15C  shows a drawing of the disposable clamping arthroscopic resection tool used during surgery. 
         FIG. 15D  shows a drawing of the disposable clamping arthroscopic resection tool used during surgery. 
         FIG. 15E  shows a drawing of the disposable clamping arthroscopic resection tool used during surgery. 
         FIG. 16  shows a perspective view of the left half of the body of the disposable clamping arthroscopic resection tool. 
         FIG. 17A  shows a top view of the lower jaw of the disposable clamping arthroscopic resection tool. 
         FIG. 17B  shows a side view of the lower jaw of the disposable clamping arthroscopic resection tool. 
         FIG. 17C  shows a perspective view of the lower jaw of the disposable clamping arthroscopic resection tool. 
         FIG. 17D  shows a sheet metal cutout view of the lower jaw of the disposable clamping arthroscopic resection tool. 
         FIG. 18A  shows a side view of the clamp actuation button and associated pushrod of the disposable clamping arthroscopic resection tool. 
         FIG. 18B  shows a bottom view of the clamp actuation button and associated pushrod of the disposable clamping arthroscopic resection tool. 
         FIG. 18C  shows a perspective view of the clamp actuation button and associated pushrod of the disposable clamping arthroscopic resection tool. 
         FIG. 18D  shows a top view of the clamp actuation button pushrod of the disposable clamping arthroscopic resection tool. 
         FIG. 19A  shows a perspective view of the cutting member of the disposable clamping arthroscopic resection tool. 
         FIG. 19B  shows a side view of the cutting member of the disposable clamping arthroscopic resection tool. 
         FIG. 19C  shows a top view of the cutting member of the disposable clamping arthroscopic resection tool. 
     
    
    
     Corresponding reference characters indicate corresponding components throughout the several views of the drawings. Skilled artisans will appreciate that elements in some of the figures are illustrated for simplicity and clarity. The figures have been drawn to scale in showing the arthroscopic resection tool. As such, the figures allow for visualization and comparison of the sizes and dimensions of some of the elements in the figures relative to other elements to help to improve understanding of various examples of the present invention. In some figures, some elements are not depicted in order to facilitate a less obstructed view of other elements. 
     It will be appreciated that the drawings are illustrative and not limiting of the scope of the invention which is defined by the appended claims. The examples shown each accomplish various different advantages. It is appreciated that it is not possible to clearly show each element or advantage in a single figure, and as such, multiple figures are presented to separately illustrate the various details of the examples in greater clarity. Similarly, not every example need accomplish all advantages of the present disclosure. 
     DETAILED DESCRIPTION 
     In the following description, numerous specific details are set forth in order to provide a thorough understanding of the present invention. It will be apparent, however, to one having ordinary skill in the art that the specific detail need not be employed to practice the present invention. In other instances, well-known materials or methods have not been described in detail in order to avoid obscuring the present invention. 
     Reference throughout this specification to “one embodiment”, “an embodiment”, “one example” or “an example” means that a particular feature, structure or characteristic described in connection with the embodiment or example is included in at least one embodiment of the present invention. Thus, appearances of the phrases “in one embodiment”, “in an embodiment”, “one example” or “an example” in various places throughout this specification are not necessarily all referring to the same embodiment or example. Furthermore, the particular features, structures or characteristics may be combined in any suitable combination and/or sub-combinations in one or more embodiments or examples. In addition, it is appreciated that the figures provided herewith are for explanation purposes to persons ordinarily skilled in the art and that the drawings are not necessarily drawn to scale. 
     The disclosure particularly describes a device and method for performing a partial release of soft tissue such as the plantar fascia ligament. Plantar fasciitis which is not resolved through conservative treatment may require surgical treatment. A partial release of a tissue is where a tissue such as a ligament or tendon is partially cut to release tension in the tissue. During partial release surgery to treat plantar fasciitis, the plantar fascia ligament is partially cut to relieve tension in the ligament and provide relief of the plantar fasciitis pain. A difficulty in partially releasing the plantar fascia ligament is in cutting the ligament smoothly and to an appropriate depth. The plantar fascia ligament may be cut from the side to remove a portion of the ligament. If the ligament is over cut, stretching or failure of the ligament may occur. Overcutting of the ligament may cause tearing of the ligament or a loss of support in the arch and chronic pain which is not easily resolved. If the ligament is cut in a manner which leaves a rough surface or spurs on the tendon, the condition of the ligament may result in residual pain or create locations where the ligament may be weakened and tear. 
       FIGS. 1A and 1B  show an overview of a method and system for treatment of plantar fasciitis using a clamping arthroscopic resection tool  100  of the present invention.  FIGS. 1A and 1B  show side views of a foot while  FIG. 1C  shows a top view of the foot and the clamping arthroscopic resection tool  100 . The foot  10  is drawn with major foot bones  20  and with the calcaneus  30  (heel bone) specifically. The plantar fascia  40  is a thick and strong band of connective tissue that attaches to the calcaneus  30  and extends along the sole of the foot  10  before connecting at the base of the toes. The plantar fascia  40  branches near the middle of the foot and is attached to each toe. The plantar fascia supports the arch of the foot. If a patient is afflicted by plantar fasciitis, the plantar fascia  40  is inflamed; causing the patient pain. The plantar fascia  40  may be partially released to reduce tension in the plantar fascia  40  and help reduce chronic inflammation. In order to partially release the plantar fascia  40 , a small first incision  50  (approximately 1 cm long) is made slightly proximal (between the body and the plantar fascia  40 ) and anterior to the plantar fascia origin at the calcaneus  30 . A second incision  60  (approximately 1 cm long) is made proximal to the plantar fascia  40  and approximately 2 cm anterior to the first incision  50 . An 18 gauge spinal needle may be used to help determine the location of a second incision.  FIG. 1A  shows the first incision  50  and the second incision  60 . 
     As is illustrated in  FIG. 1B , an arthroscope  80  is introduced into the plantar fascia space through the second incision  60 . The arthroscope  80  is used to introduce saline into the plantar fascia space at low pressure to create an operative space  70  within the tissue surrounding the plantar fascia  40 . During the surgery, the arthroscope  80  typically remains in the second opening  60  and other tools are introduced into the operative space  70  through the first incision  50 . A shaver may be introduced into the operative space  70  through the first incision  50  and then used to debride any subcalcaneal bursa tissue to allow better visualization of the plantar fascia  40 . 
     The plantar fascia  40  is inspected to identify any fraying or tearing of the plantar fascia  40 . Fraying of the plantar fascia  40  is similar to an unraveling rope and presents poorly organized tissue. Plantar fascia tears are typically interstitial, longitudinal tears which are in line with the long axis of the plantar fascia  40 . The plantar fascia  40  is debrided until stable, organized tissue remains. Once the plantar fascia debridement is complete, the partial plantar fascia release may be performed with a clamping arthroscopic resection tool  100 . The clamping arthroscopic resection tool  100  is inserted into the operative space  70  through the incision  50 .  FIGS. 1B and 1C  show the arthroscope  80  and the clamping arthroscopic resection tool  100  inserted into incisions  60  and  50  respectively. The goal of the release is often to release ⅓ to ½ of the plantar fascia  40 . In other words, the goal of the surgical release is often to remove approximately ⅓ to ½ of the lateral width of the plantar fascia  40  in the area of the incision  50 ; cutting completely through the vertical thickness of the plantar fascia  40 . 
     As can be seen in  FIG. 1C , the clamping arthroscopic resection tool  100  includes clamping jaws which may extend across all of or across a large portion of the plantar fascia  40 . The clamping jaws extend farther across the plantar fascia  40  than the cutting blade will cut. This allows the surgeon to securely hold the plantar fascia  40  both before and after resection of the plantar fascia. As shown in  FIG. 1C  and illustrated in  FIGS. 2 through 5 , the clamping jaws of the clamping arthroscopic resection tool  100  may extend laterally across and hold approximately ½ to all of the lateral width of the plantar fascia  40  during resection of the plantar fascia  40 . More preferably, the clamping arthroscopic resection tool  100  may extend laterally across and hold approximately ⅔ to all of the lateral width of the plantar fascia  40 , or alternatively approximately ⅔ to ¾ of the lateral width of the plantar fascia  40 , during resection of the plantar fascia  40 . The clamping plantar fascia resection tool  100  includes clamping jaws which extend distally farther than its cutting blade to allow a surgeon to securely hold the plantar fascia  40  during the resection of the plantar fascia  40  and maintain precise control over the resection. 
     Additional debridement with a shaver may be required at this time to make sure that stable, organized plantar fascia fibers remain. The plantar fascia  40  should be inspected as far proximally as possible to ensure there is no impingement of the calcaneus  30  on the plantar fascia  40  and, if necessary, calcaneal exostectomy may be performed with a shaver or a burr. The plantar fascia should also be visualized as far distally as possible to ensure the integrity of the entire plantar fascia. Once any debridement is complete, the operative space  70  is irrigated to avoid leaving any debris behind. The incisions  50 ,  60  are closed with suture and the wounds are dressed and cared for. 
     During surgery, it is important to properly cut the plantar fascia  40 . Remaining fibrous spurs can cause problems such as irritation or inflammation of the plantar fascia and surrounding tissues or may provide weakened locations where the plantar fascia  40  may tear. An overcut plantar fascia  40  may provide insufficient strength and can continue to tear little by little and, over time leave a patient without an arch in the foot. An overcut plantar fascia  40  may not be strong enough and may then present chronic pain and inflammation. The clamping arthroscopic resection tool  100  assists with many of these difficulties. The clamping arthroscopic resection tool  100  allows for better visualization of the entire width of the plantar fascia  40  and for controlled cutting of the plantar fascia  40 . The clamping arthroscopic resection tool  100  clamps and holds the plantar fascia  40  while cutting and cuts perpendicularly through the plantar fascia  40  at a predetermined depth. The clamping arthroscopic resection tool  100  provides for safe and repeatable release of the plantar fascia, gastrocnemius, carpal tunnel, and for other soft tissue releases. 
       FIGS. 2 through 5  show different views of an embodiment of the clamping arthroscopic resection tool  100 .  FIG. 2  shows a side view of the clamping arthroscopic resection tool  100 .  FIG. 3  shows a perspective view of the clamping arthroscopic resection tool  100 .  FIGS. 4A and 4B  show bottom and top views of the clamping arthroscopic resection tool  100 .  FIG. 5  shows a disassembled view of the clamping arthroscopic resection tool  100 . 
     The clamping arthroscopic resection tool  100  includes a first body member  104  and a second body member  108  which are pivotably attached to each other at a pivot  112 . The first body member  104  includes a serrated jaw  116 , a shank  120 , and a handle such as a finger ring  124 . The serrated jaw  116  is disposed distally from the pivot  112  and the shank  120  and finger ring  124  are disposed proximally from the pivot  112 . The first body member also includes a ratcheting clamp member  128  which extends from the shank  120  or finger ring  124  towards the second body member  108 . The second body member  108  also includes a serrated jaw  132 , a shank  136 , and a handle such as a finger ring  140 . The serrated jaw  132  is disposed distally from the pivot  112  and the shank  136  and finger ring  140  are disposed proximally from the pivot  112 . The second body member also includes a ratcheting clamp member  144  which extends from the shank  136  or finger ring  140  towards the first body member  104 . The first serrated jaw  116  and the second serrated jaw  132  are disposed adjacent each other and the serrated surfaces of these jaws face each other to allow the arthroscopic resection tool  100  to clamp tissue between the serrated jaws. The finger rings  124 ,  140  allow a person to place their fingers therein during use of the clamping arthroscopic resection tool  100 ; allowing the person to both guide and move the tool  100  as well as to open and close the serrated jaws  116 ,  132 . 
     The first body member  104  and the second body member  108  rotate with respect to each other about the pivot  112 , allowing the jaws  116 ,  132  to be brought towards or away from each other by moving the finger rings  124 ,  140  towards each other or away from each other. When the serrated jaws  116 ,  132  are brought in relatively close proximity to each other, the ratcheting clamp members  128 ,  144  engage each other; allowing complementary shaped ratcheting teeth  148  formed on both the first clamp member  128  and the second clamp member  144  to engage each other and prevent the jaws  116 ,  132  from moving away from each other until an additional clamping force and/or lateral pressure is applied to the finger rings  124 ,  140  to unlock the jaws  116 ,  132  by moving the ratcheting clamp members  128 ,  144  away from each other. In this manner, the clamping arthroscopic resection tool  100  may be used to grip a tissue such as the plantar fascia  40  and lock onto the plantar fascia to hold it securely. The clamping arthroscopic resection tool  100  is designed such that the jaws  116 ,  132  may clamp onto tissues which are between 0 mm and 10 mm thick, and more preferably tissues between 2 mm and 5 mm thick while the finger bows  124 ,  140  remain in a comfortable position and the clamp members  128 ,  144  engage each other to clamp the clamping arthroscopic resection tool  100  onto the target tissue. 
     The clamping arthroscopic resection tool  100  includes a third body member  152  which forms a cutting attachment. The cutting attachment  152  is pivotably attached to the first body member  104  and second body member  108  and may be attached to the first body member  104  and second body member  108  at the pivot  112  and pivot about the pivot  112 . The cutting attachment  152  includes a cutting blade  156  which extends distally away from the pivot  112  and which is disposed between the first jaw  116  and second jaw  132 . The cutting attachment also includes a shank  160  and a finger grip  164 . The shank  160  and the finger grip  164  extend proximally away from the cutting blade  156  and proximally away from the pivot  112 . The shank  160  and the finger grip  164  extend generally along the shank  136  of the second body member  108 . A spring  168 , or other suitable biasing element, is attached to the second body member  108  and to the cutting attachment  152  to bias the cutting attachment finger grip  164  away from the second body member shank  136 . The spring  168  pushes the shank  160  of the cutting attachment  152  away from the shank  136  of the second body member  108 . 
     The biasing of the spring  168  moving the finger grip  164  away from the shank  136  and thereby moves the blade  156  away from the first jaw  116  to a position adjacent the second jaw  132  where the blade  156  does not extend past the gripping surface of the second jaw  132  and will not cut tissue placed between the first and second jaws  116 ,  132 . The blade  156  may be disposed in a slot formed in the second serrated jaw  132  or may be located next to the serrated jaw  132 . A stop may be formed on the second serrated jaw  132  or on the shank  136  which stops the movement of the cutting attachment  152  against the biasing of the spring  168  and keeps the cutting attachment in a retracted position unless moved by a person. 
     The spring  168  allows a person to place the clamping arthroscopic resection tool  100  so that a target tissue is positioned between the first jaw  116  and second jaw  132  and clamp the clamping arthroscopic resection tool  100  onto the tissue so that the tissue is held securely between the first jaw  116  and the second jaw  132  without cutting the tissue. Movement of the finger grip  164  towards the shank  136  of the second body member  108  will move the blade  156  past the clamping surface of the second jaw  132 , through tissue positioned between the first jaw  116  and second jaw  132  and adjacent the first jaw  116 . Releasing the finger grip  164  will allow the spring  168  to retract the blade  156  from adjacent the first jaw  116  to its resting position adjacent the second jaw  132 . The finger grip  164  extends proximally towards the second finger bow  140  and stops short of the second finger bow  140  to leave a space between the finger grip  164  and the second finger bow  140 . This allows a surgeon to manipulate the clamping arthroscopic resection tool  100  within the operative cavity  70  and clamp the tool  100  onto the plantar fascia  40  without contacting the finger grip  164  and operating the blade  156 . The design also allows the surgeon to operate the finger grip  164  and blade  156  while still maintaining control of the clamping arthroscopic resection tool  100 . 
     The second jaw  132  includes an indicator mark  172  along the side of the second jaw  132  at a position adjacent the tip of the cutting blade  156 . If desired, the first jaw  116  may also include a correspondingly placed indicator mark  176  on the side of the first jaw  116  at the location where the tip of the cutting blade  156  meets the first jaw  116  when used to cut tissue. The indicator mark  172  shows how far the blade  156  extends relative to the length of the jaws  116 ,  132  and shows the distal extent to which the blade  156  will cut tissue during surgery. The indicator mark  172  is particularly useful when used in combination with an arthroscope during arthroscopic surgery as the indicator mark can be seen from the arthroscope  80 . 
     The clamping arthroscopic resection tool  100  allows the surgeon to hold and position the plantar fascia  40  with the jaws  116 ,  132  and allows the surgeon to visualize the size and shape of the plantar fascia  40 . The surgeon is able to hold the plantar fascia  40  between the jaws  116 ,  132  and, using the indicator mark  172 , visualize the fraction of the plantar fascia which will be cut by the blade  156  according to the present position of the clamping arthroscopic resection tool  100  relative to the plantar fascia  40 . The plantar fascia  40  does not move relative to the jaws  116 ,  132  or to the blade  156  while the plantar fascia is cut so the cut is precisely as determined by the surgeon while clamping the plantar fascia between the jaws  116 ,  132 . 
     Referring to  FIGS. 4A and 4B , bottom and top views of the clamping arthroscopic resection tool  100  are shown. It can be seen how the cutting attachment  152  extends generally parallel to the shank  136  of the second body member  108 . The cutting attachment  152  may be bent between the shank  160  and the finger grip  164  to provide a more comfortable finger grip  164 . The cutting blade  156  may be centered laterally relative to the width of the clamping arthroscopic resection tool  100 . As seen, the cutting blade  152  may be placed between the first body member  104  and the second body member  108  and these three components may be held together by a pin at the pivot  112 . The second jaw  132  may be formed with a slot  180  which extends through the thickness of the second jaw  132  and which receives the cutting blade  156  therethrough. The slot  180  allows the cutting blade  156  to pass through the center of the proximal portion of the second jaw  132 . This allows the sharpened cutting edge of the cutting blade  156  to be located beneath the clamping surface of the second jaw  132  in a retracted position. The spring  168  biases the cutting blade  156  into the retracted position. When the finger grip  164  is pressed, the sharpened edge of the cutting blade  156  is extended beyond the clamping surface of the second jaw  132  and passes through a tissue held between the first jaw  116  and the second jaw  132 . The first jaw  116  may have a small recess or a slot  208  ( FIG. 5 ) formed in its clamping surface to allow the cutting blade  156  to pass completely through the tissue and make a complete cut. 
       FIG. 5  shows a disassembled view of the clamping arthroscopic resection tool  100 . The pivot  112  is formed by a hole  184  formed in the first body member  104 , a hole  188  formed in the second body member  108 , a hole  192  formed in the third body member  152 , and a pin  196 . The hinge  112  could be formed from alternate structures such as a bolt which passes through these holes  184 ,  188 ,  192 , or a post formed in place of a hole on one of the body members  104 ,  108 ,  152 . It will be appreciated that the third body member (cutting attachment)  152  need not pivot about the same axis or pivot point as the first body member  104  and second body member  108 , although this is convenient. The second body member  108  may include a hole  200  or other attachment structure which allows the spring  168  to attach to the second body member. The third body member  152  may similarly include a hole  204  for attachment to the spring  168 . Alternatively, the second body member  108  and the third body member  152  may each have a post which engages a coil compression spring located between the second body member  108  and the third body member  152  to push these apart and bias the cutting blade  156  into a retracted position. These structures bias the third body member  152  relative to the second body member  108  so that the cutting blade  156  is held in a retracted, non-cutting position. In this non-cutting position, the cutting blade  156  may be located in the slot  180  formed in the second jaw  132 . As seen, the second jaw  132  may define a generally U shaped structure extending forwards towards the distal end of the clamping arthroscopic resection tool  100 , laterally in front of the slot  180 , and backwards proximally. This shape encloses the cutting blade  156  in the second jaw  132  and protects the cutting blade  156  from damage as well as protecting tissue from inadvertent cutting. As seen, the cutting blade  156  may extend along a proximal portion of the first jaw  116  and second jaw  132 . The first jaw  116  and second jaw  132  also have distal portions which extend distally beyond the cutting blade  156 . Accordingly, the cutting blade  156  may extend along approximately ½ of the clamping jaws  116 ,  132 , or along between approximately ⅓ and ⅔ of the clamping jaws. Because the distal portions of the clamping jaws  116 ,  132  extend beyond the cutting blade  152 , the distal portions of the clamping jaws  116 ,  132  remain attached to the plantar fascia  40  when it is cut. 
       FIG. 5  also illustrates how the first jaw  116  may also include a slot or channel  208  which receives the cutting blade  156  as it is moved into a cutting position. The slot  208  in the first jaw  116  allows the cutting blade  156  to pass completely through and beyond the target tissue to cut completely through the tissue. The first jaw  116  may define a generally U shaped structure extending forwards towards the distal end of the clamping arthroscopic resection tool  100 , laterally in front of the slot  208 , and backwards proximally. This shape allows the cutting blade  156  to bypass the first jaw  116  and pass completely through the tissue being cut rather than using the first jaw  116  as an anvil and cutting the tissue against the first jaw  116 . This blade and jaw design produces a clean cut in the target tissue. 
       FIGS. 6A through 6E  show drawings of the clamping arthroscopic resection tool  100  used during surgery. These drawings also show a cross section of the foot  10  during surgery. These drawings show a view of the operative space  70  and of the clamping arthroscopic resection tool  100  which is similar to what a surgeon may see from the arthroscope  80  during surgery. As discussed above, the foot  10  has been prepared for surgery and a first incision  50  and a second incision  60  have been made in the foot. A 1 cm incision will allow insertion of a 6 mm to 6.5 mm diameter tool, and the clamping arthroscopic resection tool  100  may be sized accordingly if it is desired to minimize the size of the incision  50 . The arthroscope  80  has been placed into the operative space  70  through the second incision  60  and the operative space  70  has been created by inflation with saline. Any initial debridement or preparation of the calcaneus  30  and/or the plantar fascia  40  has been performed. The clamping arthroscopic resection tool  100  is introduced into the operative space  70  through the first incision  50 . During insertion of the clamping arthroscopic resection tool  100 , the first jaw  116  and second jaw  132  may be clamped against each other and the clamp members  128  and  144  may be locked together. The first jaw  116  or first body member  104  may include a pin or wall which prevents the blade  156  from extending past the outer surface of the first jaw  116  in order to minimize any risk of accidental cutting while inserting or manipulating the clamping arthroscopic resection too.  100 . 
     The clamping arthroscopic resection tool  100  may be maneuvered within the operative space  70  into a desired position relative to the plantar fascia  40  as shown in  FIG. 6B . The surgeon will position the clamping arthroscopic resection tool  100  at a desired length along the length of the plantar fascia  40 . The surgeon may release the engagement of the first clamp member  128  and second clamp member  144  and open the jaws  116 ,  132  of the clamping arthroscopic resection tool  100  as shown in  FIG. 6C  by moving the first finger loop  124  and the second finger loop  140  away from each other. The surgeon may then place the first jaw  116  and second jaw  132  of the clamping arthroscopic resection tool  100  on opposing sides of the plantar fascia  40  as shown in  FIG. 6D  and maneuver the clamping arthroscopic resection tool  100  into a desired position relative to the plantar fascia  40 . The clamping arthroscopic resection tool  100  is placed in a position where it crosses the plantar fascia  40  transversely as is also shown in  FIG. 1B . 
     Using the arthroscope  80 , the surgeon can visualize the size of the plantar fascia  40  well using the jaws  116 ,  132  of the clamping arthroscopic resection tool  100 . The indicator mark  172  on clamping jaw  132  (as well as a corresponding indicator mark on clamping jaw  116  if provided) may be used by the surgeon to assess the depth of cut of the clamping arthroscopic resection tool  100  and to visually divide the plantar fascia  40  into a cut portion and an uncut portion while conducting the surgery. The indicator mark  172  allows the surgeon to precisely assess how much of the plantar fascia  40  will remain uncut and how much of the plantar fascia will be cut during surgery. The clamping arthroscopic resection tool  100  thus allows a surgeon to precisely evaluate the size of the plantar fascia  40  and to determine an amount of the plantar fascia  40  to resect. 
     Once the clamping arthroscopic resection tool  100  is placed in a desired position across the plantar fascia  40 , the surgeon may clamp the clamping arthroscopic resection tool  100  onto the plantar fascia  40  by applying pressure to the finger bows  124 ,  140 . The first ratcheting clamp member  128  and the second ratcheting clamp member  144  engage each other and the clamping arthroscopic resection tool  100  is securely attached to the plantar fascia  40 . The surgeon may easily control the pressure applied to the plantar fascia by the clamping arthroscopic resection tool  100 . The first clamp member  128  and the second clamp member  144  engage each other and prevent loosening of the clamping arthroscopic resection tool  100  unless released by the surgeon. Once the clamping arthroscopic resection tool  100  is clamped onto the plantar fascia  40 , the depth of cut through the side of the plantar fascia  40  is fixed and does not change as the surgeon completes the release. 
     As shown in  FIG. 6E , the surgeon may then apply pressure to the finger grip  164  of the third body member  152 , moving the blade  156  through the plantar fascia  40  so that the distal end of the blade  156  passes through the plantar fascia  40  at the indicator mark  172 . The cut through the plantar fascia  40  is made at the precise depth indicated by the indicator mark  172  as previously determined by the surgeon&#39;s positioning of the clamping arthroscopic resection tool  100 . The cut through the plantar fascia  40  is also made perpendicularly through the plantar fascia  40  and the plantar fascia  40  is cut evenly with the blade  156  cutting through the plantar fascia  40  at the same depth from the top to the bottom of the plantar fascia. After cutting the plantar fascia  40 , the surgeon may release pressure on the finger grip  164  and allow the cutting blade  156  to move to a retracted position. The surgeon may then unlock the first clamp member  128  and second clamp member  144  to release the clamping arthroscopic resection tool  100  from the plantar fascia  40 . The surgeon may, in like manner, make any other necessary cuts in the plantar fascia  40  and may remove the clamping arthroscopic resection tool  100  from the operative space  70  and from the foot  10 . 
     In viewing  FIGS. 6A through 6E , it can be seen how the clamping arthroscopic resection tool  100  may be made with a neck  212  located proximally of the jaws  116 ,  132  which is a reduced size compared to the jaws  116 ,  132 . The reduced size neck  212  is located between the clamping jaws  16 ,  132  and the pivot  112 . The reduced size of the neck  212  allows the clamping arthroscopic resection tool  100  to be more easily maneuvered through a small incision  50 . Similarly, the clamping arthroscopic resection tool  100  is made relatively small at the pivot  112  to allow for use in through a minimal incision  50 . The clamping arthroscopic resection tool  100  may be constructed such that the indicator mark  172  and distal edge of the cutting blade  156  are located between approximately 2.5 cm and 3 cm from the pivot  112 . This sizing allows the jaws  116 ,  132  to be opened and maneuvered within the operative space  70  created within the foot  10  while reduced neck  212  and the pivot  112  are at or near the incision  50  and allows for operation of the clamping arthroscopic resection tool  100  through a small incision  50 . 
       FIGS. 7A through 7C  show bottom, side, and top view drawings of the second body member  108 . These figures illustrate how the slot  180  is positioned such that it extends through a proximal and central position on the second jaw  132 . The slot  180  is aligned with the central axis of the clamping arthroscopic resection tool  100 . From the neck  212 , the second jaw  132  extends distally towards the tip of the clamping arthroscopic resection tool  100 , laterally, and then proximally away from the tip of the clamping arthroscopic resection tool  100  in a U or V shape. This may result in the jaw  132  having a freestanding side  216 . Also visible are serrations  220  formed on the surface of the second jaw  132  to aid in gripping the tissue. 
       FIGS. 8A through 8C  show bottom, side, and top view drawings of the first body member  104 . These figures illustrate how the channel/slot  208  is formed in the first jaw  116 . The slot  208  is positioned such that it extends into a proximal and central position on the first jaw  116 . The slot  208  may be formed so that it extends downwardly through the first jaw  116 . Alternatively, the slot  208  may be formed so that it extends downwardly into the first jaw  116  through the clamping surface of the jaw  116  but does not extend completely through the thickness of the first jaw  116 . This provides several benefits. Forming the first jaw  116  so that the slot  208  does not extend through the jaw  116  strengthens the jaw  116  as compared to extending a slot completely through the jaw; allowing the jaw  116  to be made thinner while retaining sufficient strength. Additionally, the blade  156  is prevented from passing through the jaw  116  since the slot  208  does not pass completely through the jaw  116 . This prevents accidental damage to tissue which may be adjacent to the outside of the jaw  116  while using the clamping arthroscopic resection tool  100  to perform a desired cut in tissue. 
     The slot  208  is aligned with the central axis of the clamping arthroscopic resection tool  100  and is aligned laterally as well as distally with the slot  180  in the second jaw  132  so that the blade  156  may pass without obstruction from a non-cutting position in the slot  180 , through tissue such as the plantar fascia  40 , and into the slot  208 . From the neck  212 , the first jaw  116  extends distally towards the tip of the clamping arthroscopic resection tool  100  as well as laterally to an extended side  224  so that the first jaw  116  is wider than the neck. The first jaw clamping surface extends distally towards the tip of the clamping arthroscopic resection tool  100 , laterally, and then proximally away from the tip of the clamping arthroscopic resection tool  100  in a U or V shape disposed around the slot  208 . The shape and size of the first jaw  116  and second jaw  132  are similar to support tissue held between the first jaw  116  and second jaw  132 . Also visible are serrations  228  formed on the surface of the first jaw  116  to aid in gripping the tissue. 
       FIGS. 9A and 9B  show side and bottom view drawings of the third body member  152 . It can be seen how the third body member  152  is reduced in size at a neck portion  212  located between the pivot hole  192  and the cutting blade  156 . 
       FIGS. 10 through 19C  show a disposable clamping arthroscopic resection tool  300 . The clamping arthroscopic resection tool  300  is similar to the clamping arthroscopic resection tool  100  discussed above in many aspects of structure and operation and is understood to be used in the manner discussed above and to function in the manner discussed above unless noted otherwise. Both the durable clamping arthroscopic resection tool  100  and the disposable clamping arthroscopic resection tool  300  have a body, a handle portion which allows a surgeon to manipulate and operate the tool, first and second clamping jaws which engage and hold a tissue between the clamping jaws, an indicator mark on the clamping jaws, and a cutting blade which moves between the clamping jaws so that the distal end of the cutting blade is located distally at the indicator mark to cut through the tissue up to the indicator mark. 
     The clamping arthroscopic resection tool  300  includes a body  304  which may be assembled from left and right halves  308 ,  312 . The body  304  includes an extending neck  316  which forms a distal upper jaw  320 . The body, neck, and upper jaw may be integrally formed. A lower jaw  324  is pivotably attached to the neck  316  adjacent the base of the upper jaw  320 . The lower jaw  324  is connected to a manual grip such as a button  328  via a pushrod  332 . The base of the button  328  is captured by the body  304  and is slidable forwards and backwards. The pushrod  332  is located within the body  304  and neck  316 . Sliding the button  328  forwards and backwards moves the lower jaw  324  towards and away from the upper jaw  320  to clamp tissue therebetween. The upper jaw  320  may include serrations  336 . Similarly, the lower jaw  324  may include serrations  340 . The button  328  may be locked into a position whereby tissue is clamped between the upper jaw  320  and lower jaw  324  via ratcheting teeth on the button  328  and ratcheting teeth on the body  304  which engage each other. An indicator mark  344  is formed on the upper jaw. The indicator mark  344  shows where a cutting blade will pass and shows the extent to which a cutting blade will cut tissue held between the upper jaw  320  and the lower jaw  324 . 
       FIG. 12  shows a partial view of a partially disassembled clamping arthroscopic resection tool  300  having a side of the body  304  removed to view internal components. The view focuses on the mechanisms which clamp target tissue and which cut the tissue. It can be seen how the body  304  includes teeth  348  which are formed adjacent a slot in which the button  328  is held. The button has complementary teeth  352 . The teeth  348  on the body  304  engage the teeth  352  on the button  328  to prevent proximal motion of the button  328  and thereby hold the button in a distal position in order to clamp tissue between the jaws  320 ,  324 . The button  328  may be pushed downwardly into the body  304  to release engagement between the teeth  348 ,  352 . It can be seen how the pushrod  332  connects to the button  328  and to the lower jaw  324  to transfer the forwards/backwards movement of the button to the lower jaw  324  and thereby create rotary movement of the lower jaw  328  to clamp target tissue between the upper jaw  320  and the lower jaw  324 . 
     A cutting member  356  is held within the body  304  and extends through the neck  316 . The cutting member  356  slides distally and proximally within the neck  316  and body  304 . The cutting member includes a finger grip such as thumb wheel  360  to allow a surgeon to move the cutting member distally and proximally by using the finger grip. The cutting member  356  is limited in its travel both distally and proximally, such as by having a notch  364  and associated end walls which engage a pin  368  or other travel limiting device. In the example clamping arthroscopic resection tool  300 , the pin  368  is the pivoting pin used to attach the lower jaw  324  to the body  304 . Alternatively, the cutting member  356  may include a tab or other structure adjacent the thumb wheel  360  which engages ends of a slot  376  ( FIG. 14 ) in the body  304  to limit the travel of the cutting member. 
     The cutting member slides between a proximal non-cutting position and a distal cutting position where the distal edge of the forwards facing blade  372  is located at the indicator mark  344 . At the proximal position, the cutting member blade  372  is retracted within the neck  316  and does not cut tissue held between the upper jaw  320  and lower jaw  324 . In the distal position, the cutting member blade extends between the upper jaw  320  and lower jaw  324  to cut tissue. A slot may be formed down the center of the clamping face of the upper jaw  320  and the center of the clamping face of the lower jaw  324  to allow the sides of the blade  372  to pass therethrough and ensure complete cutting of the target tissue. In a manner similar to that discussed above, the clamping arthroscopic resection tool  300  can be clamped to a desired tissue while using the indicator mark  344  to determine the amount of tissue which will be cut and the amount of tissue which will not be cut, and then cut the tissue with the cutting member  356 . 
       FIGS. 15A through 15E  show use of the clamping arthroscopic resection tool  300 . The clamping arthroscopic resection tool  300  is used in the manner discussed above unless otherwise noted and some details of its use have not been duplicated here. As shown in  FIG. 15A , the clamping arthroscopic resection tool  300  may be brought into a position adjacent the first incision  50  with its jaws  320 ,  324  closed. The clamping arthroscopic resection tool  300  may be inserted into the operative cavity  70  through the first incision  50  as shown in  FIG. 15B . The clamping arthroscopic resection tool  300  may be brought to a position adjacent the plantar fascia  40  and the jaws  320 ,  324  of the clamping arthroscopic resection tool  300  may be opened to receive the plantar fascia  40 . As shown in  FIG. 15D , the indicator mark  344  may be seen through the arthroscope  80  and used to assist the surgeon in placing the jaws  320 ,  324  around the plantar fascia  40  and dividing the plantar fascia  40  into a cut portion and uncut portion. The surgeon may then move the button  328  to clamp the plantar fascia  40  between the upper jaw  320  and the lower jaw  324 . As shown in  FIG. 15E , the surgeon may then use the finger grip  360  to move the blade  372  through the plantar fascia  40  and cut the plantar fascia  40  up to the indicator mark  344 . The surgeon may then retract the cutting blade  372  and release the clamping jaws  320 ,  324 . After completing any other necessary cuts, the surgeon may remove the clamping arthroscopic resection tool  300  from the first incision  50 . 
       FIG. 16  shows a perspective view of the left half  308  of the body  304 . The body half  308  includes a slot  380  to house the pushrod  332 , a channel or slot  384  to house the cutting member  356 , a slot to accept the button  328  and permit its movement, teeth  348  to limit the movement of the button  328 , and a hole  388  to pivotably mount the lower jaw  324 . 
       FIGS. 17A through 17D  show top, side, perspective, and sheet metal cutout views of the lower jaw  324 . The lower jaw  324  includes a hole or holes  392  to receive the pushrod  332  and holes  396  to accept the pin  368  used to mount the lower jaw  324  to the body  304 . 
       FIGS. 18A through 18D  show side, bottom, and perspective views of the clamp actuation button  328  and associated pushrod  332  and a top view of the pushrod  332 . The button  328  is contoured to permit easy manual manipulation with the thumb. The pushrod  332  is attached to the button  328 , but these may be formed as a single piece. The distal end(s) of the pushrod  332  is formed with a hole  400  or other attachment structure to engage the lower jaw  324 . 
       FIGS. 19A through 19C  show perspective, side, and top views of the cutting member  356 . The cutting member  356  includes a finger grip such as a thumbwheel  360  with grip texture  408  which is rotatably attached to the cutting member body with a pin  404 . The thumbwheel may be rolled against the body of the clamping arthroscopic resection tool  300  with the thumb to move the cutting member  356  forwards and backwards to cut tissue and retract the blade  372 . 
     In the manner discussed above, the clamping arthroscopic resection tool may be used to perform other tissue releases and surgical cuts. It is advantageous in these situations as it allows for more accurate cutting of the tissue. The clamping arthroscopic resection tool is advantageous as it allows a surgeon to release the plantar fascia and other soft tissues in a manner which allows for easier observation of the dimensions of the tissue, improved visual separation of the tissue into a desired cut portion and a non-cut portion, and cutting of the tissue precisely to an indicator mark placed at a previously determined location along the tissue. 
     The above description of illustrated examples of the present invention, including what is described in the Abstract, are not intended to be exhaustive or to be limitation to the precise forms disclosed. While specific examples of the invention are described herein for illustrative purposes, various equivalent modifications are possible without departing from the broader scope of the present claims. Indeed, it is appreciated that specific example dimensions, materials, etc., are provided for explanation purposes and that other values may also be employed in other examples in accordance with the teachings of the present invention.