Standardization of the Radiographic Study of the Foot Using the Niza Box / Padronização do estudo radiográfico do pé pela caixa Niza

Abstract Objective This study proposes the Niza box, a device created to reduce interpretive errors among professionals and facilitate the correct positioning of structures by standardizing orthopedic radiography of the foot in anteroposterior, loaded, and Saltzman views. Methods Descriptive study based on material collected at an Orthopedics Ambulatory from a tertiary service in a large Brazilian city. The X-ray device was a Lotus X, model HF 500 M, 500 milliamperes and 125 kilovolts capacity, 100 cm focus-film distance, and 24 × 30 cm radiographic chassis. Device controls were set at 100 mA, 5 mA/sec, and 60 kilovolts, depending on the variable size of the foot. The same team of previously trained radiography technicians performed the tests under the authors' supervision. The chassis were positioned in three specific Niza box spaces per the proposed incidence. Data from 50 images from people between 18 and 70 years old were analyzed. Results Radiographs taken using the proposed device usually had a satisfactory quality, allowing correct identification of the anatomical elements of the foot and ankle and angular reconstruction. Small image variations due to foot size were acceptable and expected, allowing radiograph standardization. Conclusion The Niza box is a good method for minimizing interference and avoiding radiographic interpretation errors, providing quality and agility to the examination, and reducing cost and unnecessary repetitions. It is an innovative, low-cost device made of recyclable and biodegradable material.

Resumo Objetivo Este estudo propõe a utilização da Caixa Niza, dispositivo criado com a finalidade de diminuir os erros interpretativos entre profissionais e facilitar o correto posicionamento das estruturas radiografadas ao padronizar as incidências radiográficas ortopédicas do pé anteroposterior, perfil com carga e Saltzman. Métodos Pesquisa descritiva, material coletado em Ambulatório de Ortopedia em serviço terciário de cidade brasileira de grande porte. Utilizado aparelho de radiografia marca Lotus X, modelo HF 500M, capacidade de 500 miliamperes e 125 quilovolts, distância foco-filme de 100cm, chassi radiográfico 24×30 cm e os comandos do aparelho ajustados para 100 mA, 5mA/seg e 60 quilovolts dependendo do tamanho variável dos pés. Exames realizados pela mesma equipe de técnicos em radiografia previamente treinados com supervisão dos autores. O chassi é posicionado em três espaços específicos da Caixa conforme a incidência proposta. Foram analisados dados de 50 imagens de pessoas entre 18 e 70 anos. Resultados A avaliação das radiografias após utilização do dispositivo proposto ocorreu de modo geral com qualidade satisfatória, permitindo correta identificação dos elementos anatômicos do pé e tornozelo e reconstrução angular. Pequenas variações nas imagens devido ao tamanho dos pés são aceitáveis e esperadas, sendo possível perceber padronização das radiografias. Conclusão A Caixa proposta se mostra um bom método de minimizar as interferências e evitar erros de interpretação radiográfica, proporcionando qualidade e agilidade ao exame, diminuindo custo e repetições desnecessárias. É inovador, um dispositivo de baixo custo, de material reciclável e biodegradável.

Luxación medial y plantar del hueso navicular asociada a fractura-subluxación calcaneocuboidea. Presentación de un caso / Medial and plantar dislocation of the navicular bone associated with a calcaneocuboid fracture-subluxation. Case report

Las luxaciones del escafoides aisladas y sin fractura son poco frecuentes. Por lo general, se presentan asociadas a fracturas del escafoides o a diversos patrones de lesión de la columna lateral. Presentamos el caso de un paciente con luxación medial y plantar del hueso navicular y fractura conminuta del proceso anterior del calcáneo y subluxación calcaneocuboidea. En el Servicio de Urgencia, se procedió a la reducción cerrada y la estabilización con agujas de Kirschner y, como tratamiento diferido, se colocaron placas en puente astragalonaviculo-cuneiforme y calcaneocuboidea de 2,0 mm, en forma transitoria, y el material de osteosíntesis se retiró a los 5 meses. El puntaje de la escala de la AOFAS fue excelente al año de seguimiento. Conclusiones: Es necesario llegar a un diagnóstico adecuado descartando lesiones de la columna lateral y reducir esta lesión en la atención de urgencia. La estabilización con placas en puente es una opción válida que podría evitar la pérdida de la reducción que se observa al retirar los clavos de Kirschner y permite una carga precoz. Nivel de Evidencia: IV

Isolated navicular dislocations are unusual. They are frequently associated with navicular fractures or diverse patterns of lateral column injuries. We report a case of a patient with medial and plantar navicular dislocation with a comminuted intra-articular fracture of the anterior process of the calcaneus and associated subluxation at the calcaneocuboid joint. The patient underwent closed reduction and Kirschner wire stabilization in the Emergency Service. As part of the deferred treatment, talonavicular-cuneiform and calcaneocuboid 2.0 mm bridge plates were temporarily placed and osteosynthesis material was removed 5 months later. The AO-FAS score was excellent in the one-year follow-up. Conclusion: An accurate diagnosis, ruling out lateral column injuries, should be done in the Emergency Service. Bridge plate stabilization is a valid option to prevent loss of reduction, which is observed when removing Kirschner wires, allowing early weight-bearing. Level of Evidence: IV

Seguridad de los portales para la reparación endoscópica del ligamento calcaneonavicular: estudio cadavérico / Endoscopic Spring ligament repair. Anatomic evaluation of portal safety

Introducción: La lesión del ligamento calcaneonavicular ha sido descrita como una de las causas de la deformidad en el pie plano del adulto. El objetivo de este artículo es describir portales modificados para el diagnóstico y la reparación endoscópica de las lesiones del fascículo superomedial del ligamento calcaneonavicular y evaluar la seguridad de los portales utilizados. Materiales y Métodos:Se llevó a cabo un estudio cadavérico con seis preparados reproduciendo una lesión del fascículo superomedial del ligamento calcaneonavicular con una punta de corte de radiofrecuencia y la posterior reparación endoscópica. Se crearon dos portales modificados para el abordaje. Luego se procedió a la disección anatómica para evaluar la seguridad de los portales en relación con las estructuras anatómicas. El primer portal se realiza inmediatamente proximal a una línea trazada desde la punta del maléolo medial dirigida al centro del talón, el segundo portal se emplaza 0,5 cm proximal a la inserción del tendón tibial posterior en el escafoides por transiluminación. Si es necesario, se coloca un portal accesorio inmediatamente dorsal al tendón tibial posterior a mitad de camino entre los dos portales antes descritos. Resultados:En todos los casos, fue posible la reparación del ligamento con el procedimiento endoscópico. En la disección anatómica de los portales, se observó una distancia promedio a las estructuras vasculonerviosas de 11,83 mm del portal proximal y de 9,66 mm del portal distal. Conclusión: Los portales modificados son seguros y permiten la visualización directa del haz superomedial del ligamento calcaneonavicular y su reparación endoscópica. Nivel de Evidencia: IV

Introduction: Calcaneonavicular ligament injury has been described as a cause of adult flat foot deformity. The objective of this study is to describe modified portals for the diagnosis and treatment of injuries to the superomedial bundle of the calcaneonavicular ligament and to evaluate the safety of the portals used. Materials and Methods: We performed a cadaveric specimen study on 6 feet, where we reproduced a lesion of the superomedial bundle of the calcaneonavicular ligament with a radiofrequency ablation device and repaired it endoscopically. Two modified portals were created for the approach and an anatomical dissection was performed to assess the safety of the portals in relation to the anatomical structures. The first portal was placed immediately proximal to a line drawn from the tip of the medial malleolus toward the center of the heel; the second portal was placed 0.5 cm proximal to the posterior tibial tendon insertion into the navicular bone, guided by transillumination. If needed, an accessory portal was placed halfway between the two previously described portals immediately dorsal to the posterior tibial tendon. Results:In all cases, ligament repair was achieved with the endoscopic procedure. In the anatomical dissection of the portals, we observed an average distance of 11.83 mm from the proximal portal and 9.66 mm from the distal portal to neurovascular structures. Conclusion:Modified portals are safe and allow direct visualization of the superomedial bundle of the calcaneonavicular ligament to perform endoscopic repair. Level of Evidence: IV

Relationship between Urate Crystal Deposits Detected by Dual-energy Computed Tomography and Bone Erosions in Symptomatic Gout Patients without Clinically Apparent Tophi

OBJECTIVE: Dual-energy computed tomography (DECT) allows sensitive detection of monosodium urate (MSU) crystal deposits in gout. However, the role of MSU deposits on DECT during the disease process of gout is not clear. The aim of our study was to evaluate the relationship between joint damage and MSU deposits detected by DECT in symptomatic non-tophaceous gout. METHODS: DECT scans of 51 gout patients without clinically apparent tophi were assessed. Individual ankle and foot joints and Achilles tendon insertion sites were evaluated for the presence of MSU deposits and bone erosions. The total volume of MSU crystal on DECT was quantified using an automated software program. Clinical and laboratory data at the time of the DECT evaluation were obtained from medical record. RESULTS: MSU deposits were detected in 92.2% of the patients evaluated. Median number and total volume of MSU deposit per patient was 5.0 and 0.6 cm3, respectively. Bone erosion was found in 54.9% of patients. MSU deposits in the first (1st) metatarsophalangeal (MTP) joints were significantly associated with presence of bone erosions (odds ratio [OR] 3.77, 95% confidence interval [CI] 1.06~13.38, p=0.040). Older age and frequent gout attack were associated with development of bone erosion in patients with MSU deposits (OR 1.12 and 2.57, 95% CI 1.04~1.22 and 1.02~6.50, p-value 0.004 and 0.047, respectively). CONCLUSION: MSU deposits and erosions were frequently detected by DECT in symptomatic non-tophaceous gout patients, and MSU deposits in 1st MTP joints were associated with presence of bone erosions especially in patients with older age and frequent gout attack.

Fracture and Dislocation of the Midtarsal Joint: A Case Report / 대한족부족관절학회지

The midtarsal joint is composed of the talonavicular and calcaneocuboid joints. It is also known as the Chopart joint. Midtarsal joint fracture and dislocation are relatively rare and frequently missed or misdiagnosed. A proper understanding about the anatomy of the midtarsal joint is an essential part in comprehending the mechanism of injury and rationale for treatment. Anatomical reduction of midtarsal joint with correction of the column in length and shape are important; however, it is technically challenging and may require open procedure. Herein, we described a case of initial open reduction and internal fixation for midtarsal joint fracture and dislocation with a brief literature review.

Effect of Rhythmic Auditory Stimulation on Hemiplegic Gait Patterns

PURPOSE: The purpose of our study was to investigate the effect of gait training with rhythmic auditory stimulation (RAS) on both kinematic and temporospatial gait patterns in patients with hemiplegia. MATERIALS AND METHODS: Eighteen hemiplegic patients diagnosed with either cerebral palsy or stroke participated in this study. All participants underwent the 4-week gait training with RAS. The treatment was performed for 30 minutes per each session, three sessions per week. RAS was provided with rhythmic beats using a chord progression on a keyboard. Kinematic and temporospatial data were collected and analyzed using a three-dimensional motion analysis system. RESULTS: Gait training with RAS significantly improved both proximal and distal joint kinematic patterns in hip adduction, knee flexion, and ankle plantar flexion, enhancing the gait deviation index (GDI) as well as ameliorating temporal asymmetry of the stance and swing phases in patients with hemiplegia. Stroke patients with previous walking experience demonstrated significant kinematic improvement in knee flexion in mid-swing and ankle dorsiflexion in terminal stance. Among stroke patients, subacute patients showed a significantly increased GDI score compared with chronic patients. In addition, household ambulators showed a significant effect on reducing anterior tilt of the pelvis with an enhanced GDI score, while community ambulators significantly increased knee flexion in mid-swing phase and ankle dorsiflexion in terminal stance phase. CONCLUSION: Gait training with RAS has beneficial effects on both kinematic and temporospatial patterns in patients with hemiplegia, providing not only clinical implications of locomotor rehabilitation with goal-oriented external feedback using RAS but also differential effects according to ambulatory function.

Forefoot plantar pressure changes of the first tarsometatarsal joint fracture-dislocation fixation by different internal fixations / 中国骨伤

<p><b>OBJECTIVE</b>To measure the changes of plantar pressure of the first tarsometatarsal joint fracture and dislocation by three different implants to provide experimental reference in selecting implants.</p><p><b>METHODS</b>Eight fresh foot specimens were made into the models of the first tarsometatarsal joint fracture and dislocation, which were fixed with 3.5 mm cortical screw, 1/4 tubular plate and compressive staple in turn. After the loading of 600 N, the changes of the plantar pressure in forefoot were measured by the method of the F-scan plantar pressure system.</p><p><b>RESULTS</b>After first tarsometatarsal joint fracture and dislocation, the peak pressure under the first metatarsal head would decrease, while the pressure under the second metatarsal head would increased,whose differences were statistically significant (P<0.05). When the first tarsometatarsal joint was fixed with screw or plate respectively; the peak pressure under the two metatarsal heads would tend to be normal. However,the staple fixation showed the statistical significant difference compared with normal state, although the peak pressure under the first and second metatarsal heads were recovered in some extent(P<0.05).</p><p><b>CONCLUSION</b>After the first tarsometatarsal joint fracture-dislocation, the plantar pressure might be compensated partly by the adjacent metatarsal heads according to the regulation of the load transfer mechanism. While the first tarsometatarsal joint fracture-dislocation was fixated by screw or plate, the plantar pressure of the forefoot would return to the normal state. However,if the joint was fixated by the staple, it would still be difficult to return the plantar pressure to be normal.</p>

[Subclinical Involvement of hands and feet joints in psoriasis patients: ultrasonography and magnetic resonance imaging study]

Objective: To evaluate musculoskeletal ultrasound [MSUS] in the detection of subclinical hands and feet joint involvement in psoriasis patients by comparison with magnetic resonance imaging [MRI]

Methods: Thirty Patients with plaque psoriasis with no clinical or radiological signs of arthritis attending outpatient dermatology clinic of Assiut University Hospitals were enrolled in the study. All patients underwent clinical examination [including dermatological and rheumatological examination], MSUS, RI, X-ray evaluation of the hands and feet joints

Results: Both MSUS and MRI were sensitive in detecting subclinical joint inflammation [synovitis], and bone abnormalities in psoriatic patients with normal conventional radiographs. Of the total examined is [2520], synovitis was detected by MSUS in 23.69%, erosions in 9.04%, and bone proliferation in 22.14%. MRI detected synovitis in 15.83%, erosions in 0.75%, and bone marrow edema in 1.35%. A significant correlation was found between the subclinical psoriatic arthritis detected by MSUS with the presence of nail psoriasis

Conclusion: Both MSUS and MRI were sensitive in detecting significant prevalence of subclinical involvement in hands and feet joints of psoriasis patients, this suggests that PsA could be a much more common disorder than was previously suspected. When comparing MSUS with MRI, MSUS identified more synovitis and erosions, and osteoproliferation was only detected by MSUS, whereas bone marrow edema was detected only by MRI

Combined Ipsilateral Fracture and Dislocation of Hip, Knee and Foot Joints: A Case Report

Although clinical cases of ipsilateral knee and hip joint dislocation have been reported, there are no reports of simultaneous ipsilateral hip, knee, and foot dislocations. We report here a case of a patient who had ipsilateral hip, knee, and foot joint dislocations, and review the relevant literature.

Alterações plantares em pacientes com artrite reumatoide / Foot alterations in rheumatoid arthritis patients

Objetivo: Identificar as alterações plantares em pacientes reumáticos. Métodos: Foram avaliados 45 pacientes com diagnóstico de artrite reumatoide, com idade igual ou acima de 20 anos, do sexo masculino ou feminino. Os pacientes foram avaliados individualmente, quando foram coletados dados sociodemográficos (idade, gênero, raça e estado civil) e realizado o exame físico dos pés. Resultados: Dos 45 pacientes avaliados, 24,4% não apresentaram acometimentos nos pés, 15,6% apresentaram lesões de pele, 24,4% lesões nas unhas, 11,1% lesões vasculares e 24,4% deformidades de dedos. Foi observado que 60% apresentaram pé plano, seguido pelo pé cavo com 31,1%, pé equino 8,9% e 42,2% não apresentaram comprometimento nos pés, sendo considerados normais. Pacientes com pés valgos foram 28,9%, 22,2% com pés dolorosos e 6,6% com pés varos. Na avaliação dos calçados, 39 dos 45 pacientes estavam usando sapatos inadequados, ou seja, 89% dos pacientes. Houve uma maior frequência de pacientes sem dor (19%), utilizando-se a EVA (0 mm) seguida de dores quantificadas em 20 mm (16%) e EM 100 mm (16%). Conclusão: Através de uma avaliação simples foi possível observar as principais alterações que acometem os pés reumatoides, levando à dor e incapacidade. Com esse estudo foi descoberta a importância de se realizar uma avaliação detalhada nos pés e calçados, a fim de melhorar a qualidade de vida desses pacientes. Futuros estudos são necessários para determinar um calçado adequado que possa reduzir as alterações plantares e aliviar a dor nos pés reumatoides.

Treatment of tarsometatarsal joint injury combined with metatarsal fracture by open reduction and internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the therapy and the key points of the tarsometatarsal joint injury combined with metatarsal fracture.</p><p><b>METHODS</b>From Jan. 2006 to Jul. 2008,19 patients with tarsometatarsal joint injury combined with metatarsal fracture were treated with opened reduction and internal fixation of Kirschner wire or screws, included 13 males and 6 females with an average age of 38.1 years ranging from 21 to 56 years. The classification of tarsometatarsal joint injury showed that there were 2 cases of inner column injury, 5 cases of inner and medial column injury, 3 cases of lateral and medial column injury, 9 cases of tri-column injury. There were 8 cases of shaft fracture, 7 of neck fracture, 19 of foundation fracture.</p><p><b>RESULTS</b>All the incisions were first stage healed without skin necrosis. The healing time of fracture was 11.2 weeks on average. All the patients were followed-up for 6 to 17 months with an average of 12.8 months. According to the standard of AOFAS, the average score was (84.500 +/- 8.553), the results were excellent in 4 cases, good in 9 cases, fair in 3, and poor in 3. The regular daily life was recovered after 6.4 months, 3 patients suffer from mild osteoarthritis.</p><p><b>CONCLUSION</b>No matter which fixed mode was used, the anatomical reduction was the most important to rebuild arches of the foot and recover medial longitudinal and lateral arch. Rebuilding arches of the foot guaranteed the integrity of the stress point scaffold and avoided the pain and limp. The anatomical reduction of tarsometatarsal joint and metatarsal was also important to rebuild the function of foot.</p>

Surgical treatment of tarsometatarsal joint complex injury / 中华外科杂志

<p><b>OBJECTIVE</b>To report the outcome of surgical treatment of tarsometatarsal joint complex injury.</p><p><b>METHODS</b>In the period from January 2003 to December 2008, 167 cases of closed tarsometatarsal joint injury were treated, including 35 cases of tarsometatarsal joint complex injury. Diagnosis was made by X-ray examination or/and CT scan. Either close or open reduction was performed and followed by internal fixation with screw or/and plate. X-ray examination was done in the regular follow-up and functional evaluation was carried out by AOFAS midfoot score system.</p><p><b>RESULTS</b>In this series 135 cases got a mean follow-up of 48 months, ranging from 12 to 75 months. Therein the 26 cases of tarsometatarsal joint complex injury had a mean postoperative AOFAS midfoot score of 67 (ranging from 48 to 75), and secondary post-traumatic arthritis in 16 cases, 12 of which had arthrodesis as a result of severe pain. The 109 cases of pure tarsometatarsal joint injury had a mean postoperative AOFAS midfoot score of 82 (ranging from 70 to 95), and secondary post-traumatic arthritis in 17 cases, only 5 of which had arthrodesis finally. Those cases of pure tarsometatarsal joint injury treated by close reduction and internal fixation with percutaneous screw got a mean postoperative AOFAS midfoot score of 87 (ranging from 82 to 95), demonstrating a significant deference (t = 2.651, P < 0.05) when compared with that of metatarsal joint complex injury.</p><p><b>CONCLUSION</b>The tarsometatarsal joint complex injury has a prognosis inferior to that of the pure tarsometatarsal joint injury, and the keys to its successful treatment are appropriate diagnosis, anatomical reduction and secure fixation of all the components of the complex.</p>

Erosive Arthropathy with Osteolysis As a Typical Feature in Polyfibromatosis Syndrome: A Case Report and a Review of the Literature

Polyfibromatosis syndrome is a rare disease entity that is characterized by various clinical features such as palmar, plantar, and penile fibromatoses, keloid formations of the skin, and erosive arthropathy. Its precise pathophysiology or etiology remains unclear. In addition to distinctive diverse skin manifestations, patients with polyfibromatosis have been previously reported to show erosive arthropathy with significant limitation of movement at affected joints. However, the presence of erosive polyarthropathy in polyfibromatosis has not emphasized in previous cases. Here, we report a case of polyfibromatosis syndrome combined with painless massive structural destruction of hand and foot joints, and review the characteristics of erosive arthropathy in previous cases.

Lesiones de lisfranc: reporte de dos casos / Lisfranc Injury: report of two cases

La Luxo-fracturas de Lisfranc tarsometatarsianas son poco frecuentes. 1 Se presenta caso 1: femenina de 34 años de edad, posterior a caída de aprox, 3 mts, con tumefacción y deformidad en medio pie Izquierdo. RX: luxación de tarsometatarsina homolateral. Caso 2, masculino de 24 años de edad, recibió traumatismo contuso en pie Izquierdo presentó tumefacción y deformidad en área tarsal media RX: luxo-fractura tarsometatarsina divergente, fractura de II-V metatarso; se realizó reducción abierta y fijación percutánea con alambres de Kirschner, sin complicaciones, coincidiendo el mismo mes de presentación, poco usual en la práctica médica, con evolución satisfactoria.

Eficácia do uso de palmilhas biomecânicas para a correção cinemática do padrão de pronação excessiva da articulação subtalar / Efficacy of using biomechanical insoles to correct the excessive subtalar pronation pattern

A presença do padrão de pronação excessiva da articulação subtalar (PPEAS) tem sido relacionada com o desenvolvimento de patologias ortopédicas nos membros inferiores. As palmilhas biomecânicas são frequentemente utilizadas com o objetivo de corrigir esse padrão. Entretanto, não existe um consenso sobre a eficácia dessas palmilhas para esse fim. O objetivo do estudo foi realizar uma revisão sistemática da literatura sobre a eficácia de palmilhas biomecânicas para corrigir parâmetros cinemáticos do PPEAS. Para a avaliação da qualidade das evidências utilizou-se a escala PEDro. 86 por cento das modificações cinemáticas alcançadas com o uso das palmilhas, nos estudos incluídos, foram a favor da correção do PPEAS e apenas 14 por cento pioraram esse padrão. Isso sugere que as palmilhas são eficazes para corrigir algumas das disfunções relacionadas ao PPEAS e quea correção desse padrão pode depender da associação do uso dessas órteses com a modificação de outras disfunções apresentadas porum paciente.

The presence of excessive subtalar pronation pattern (ESPP)has been related to the development of orthopedic pathologies inthe lower limbs. Biomechanical insoles are frequently used in anattempt to correct this pattern. However, there is no consensus aboutthe insoles’ effi cacy for this purpose. Th e aim of this study was tosystematically review the literature about the biomechanical insoles efficacy in correcting the kinematics parameters of the ESPP. The PEDro scale was used to assess the quality of the evidence. 86 percent of the kinematic changes achieved with the use of insoles were in favorof the correction of the ESPP and only 14 percent worsened this pattern. This suggests that the use of biomechanical insoles is efficacious for correcting some of the dysfunctions related to ESPP and this correction might depend on the association with therapeutic modifications of other dysfunctions shown by the patient.

Causes and countermeasure of complications in operative management of intra - articular fracture of calcaneus / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the probable causes of the post-surgery complications with the intra-artcular fracture of calcaneus, the proper steps for prevention and solution.</p><p><b>METHODS</b>Seventy-one patients (76 injured feet) included 49 males and 22 females aged from 19 to 56 years old (mean 35.6 years). According to Sanders' classification, 23 cases (24 injuried feet) belonged to type II, 36 (38 injured feet) were type III, the remain 12 (14 injured feet) met the criteria of type IV. All the patients received the operation of open reduction, autogenous bone grafting and internal fixation with stainless steel plates.</p><p><b>RESULTS</b>Thirteen injuried feet developed early complications. Two injuried feet got the superficial layer of the wound disrupted and infected, I had the deep layer of the wound disrupted and infected. Cutaneous necrosis at the pointed end of the wound occurred in 7 cases. Another 1 developed osteomyelitis. Two cases suffered from sural nerve damage. Two injuried feet developed late complications, both of them suffered from arthritis of talocalcaneal joint. All the patients were followed up at least 6 months (ranged from 6 to 42 months, mean 19 months). According to Kerr's post-surgery evaluation criteria, 34 injuried feet were excellent, 32 were fine, 9 were acceptable, only 1 was bad.</p><p><b>CONCLUSION</b>If proper measures are taken, the post-surgery complications of intra-articular fracture of calcaneus will be reduced. This requires us to be strict in selecting operation indication, to make a good plan and preparation, to select a right time for operation, to improve surgical skills and pay more attention to peri-surgery nursing. If complications happen, according measures should be taken in order to get a better outcome.</p>

Cisto epidermóide nos pés: relato de caso / Epidermoid cyst on the foot: case report

Tumores benignos são responsáveis pela maioria das lesões tumorais nos pés. Neuroma de Morton, fasciite plantar e nódulos reumatóides respondem por 60% a 70% de todas estas doenças. Usualmente, mono-artrite na face plantar dos pés de caráter mecânico induz em mulheres jovens aos diagnósticos referidos. O cisto epidermóide, apesar de ser uma lesão benigna, não é lembrado no diagnóstico dife­rencial de nódulos dolorosos nos pés. O conhecimento dos achados patológicos destas lesões extra-articulares nos pés ajuda na interpretação da ressonância magnética (RM)