Investigation of the relationship between foot deformities and radiographic measurements of the talus and calcaneus / Investigación de la relación entre las deformidades del pie y las mediciones radiográficas del talo y del calcáneo

SUMMARY: The weight of the body is transmitted to the foot through the subtalar joint and talus. Considering the important location of the talus and calcaneus, the morphological structures of these bones may affect the biomechanics of the subtalar joint. At the same time, the morphological structure of these bones is important in some common foot deformities. We aimed to investigate whether the various measurements of the talus and calcaneus are associated with different foot deformities in this study. In this study, radiography images of 158 (72 male and 86 female) patients within the mean age of 44 years were retrospectively examined. Eleven different measurements of the talus and calcaneus were obtained from the lateral and antero-posterior radiographs of the patients. A total of 158 patient's routine clinic radiographs were retrospectively assessed, which have calcaneal spur (n=63), hallux valgus (n=32) and control group (n=63). We determined that the body height of the calcaneus, maximum width of the head of the talus, minimum anterior width of the calcaneus were significantly different between calcaneal spur group and control group. Maximum length fibular malleolar facet of the talus was significantly different between age groups. And we determined that the calcaneal index was significantly different between hallux valgus group and control groups. Also all measurements were significantly different between males and females. As a result, some measurements that significantly determine the morphology of the talus and calcaneus were found to be significant between deformity groups and control groups. We think that our study will contribute to the literature as it is the first study in which the measurements obtained from the radiographic images of the talus and calcaneus are associated with foot deformities.

El peso del cuerpo se transmite al pie a través de la articulación subtalar y el talo. Teniendo en cuenta la importante ubicación del talo y el calcáneo, las estructuras morfológicas de estos huesos pueden afectar la biomecánica de la articulación subtalar. Al mismo tiempo, la estructura morfológica de estos huesos es importante en algunas deformidades comunes del pie. Nuestro objetivo fue investigar si las diversas medidas del talo y el calcáneo están asociadas con diferentes deformidades del pie en este estudio. Se examinaron retrospectivamente imágenes radiográficas de 158 pacientes (72 hombres y 86 mujeres) con una edad promedio de 44 años. Se obtuvieron once medidas diferentes del talo y el calcáneo a partir de las radiografías lateral y anteroposterior de los pacientes. Se evaluaron retrospectivamente un total de 158 radiografías clínicas de rutina de los pacientes, los cuales tenían espolón de calcáneo (n=63), hallux valgus (n=32) y grupo control (n=63). Determinamos que la altura del cuerpo del calcáneo, el ancho máximo de la cabeza del talo, el ancho anterior mínimo del calcáneo fueron significativamente diferentes entre el grupo con espolón calcáneo y el grupo control. La longitud máxima de la faceta maleolar fíbular del talo era significativamente diferente entre los grupos de edad. También determinamos que el índice calcáneo fue significativamente diferente entre el grupo de hallux valgus y los grupos controles. Además, todas las medidas fueron significativamente diferentes entre hombres y mujeres. Como resultado, algunas medidas que determinan la morfología del talo y el calcáneo resultaron significativas entre los grupos de deformidad y los grupos controles. Estimamos que nuestro estudio contribuirá a la literatura debido a que es el primer reporte en el que las medidas obtenidas de las imágenes radiográficas del talo y el calcáneo se asocian con deformidades del pie.

A comprehensive study of the anatomical variations of the posterolateral tubercle of talus / Un estudio integral de las variaciones anatómicas del tubérculo posterolateral del talo

SUMMARY: The aim of our study was to determine the prevalence and the anatomical variations of the posterolateral tubercle of talus in relation to sex on CT imaging. A total of 1478 ankle CT scans was retrospectively reviewed for the different anatomical variants of the posterolateral tubercle of talus, the type and size of os trigonum. Normal sized lateral tubercle was found in 46.1 %, an enlarged posterolateral tubercle (Stieda's process) in 26.1 %, os trigonum in 20.5 % and almost absent tubercle in 7.3 %. A statistically higher prevalence of Stieda's process was found in males while os trigonum was higher in females (p0.05). The posterolateral tubercle of talus and its accessory ossicle, the os trigonum, could vary morphologically. The data of this study could be helpful in understanding the clinical problems that could be associated with some of these variants.

RESUMEN: El objetivo de nuestro estudio fue determinar la prevalencia y las variaciones anatómicas del tubérculo posterolateral del talo en relación con el sexo en la imagen de TC. Se revisaron retrospectivamente un total de 1478 TC de tobillo para las diferentes variantes anatómicas del tubérculo posterolateral del talo, el tipo y tamaño del os trigonum. Se encontró tubérculo lateral de tamaño normal en 46,1 %, tubérculo posterolateral (proceso de Stieda) en 26,1 %, os trigonum en 20,5% y tubérculo casi ausente en 7,3 %. Se encontró una prevalencia estadísticamente más alta del proceso de Stieda en los hombres, mientras que el os trigonum fue mayor en las mujeres (p 0,05) no se observaron diferencias significativas. El tubérculo posterolateral del talo y su osículo accesorio, el os trigonum, podrían originar problemas clínicos que podrían estar asociados con algunas de estas variantes.

Inestabilidad cronica lateral del tobillo: comparacion entre la reparacion de brostrom-gould y una tecnica artroscopica / Chronic Lateral Ankle Instability: Comparison Between Brostrom-Gould Repair And An Arthroscopic Technique

Introducción La inestabilidad crónica lateral del tobillo es una patología frecuente en las personas que sufren esguinces. El tratamiento inicial es conservador y de no funcionar se recomienda el tratamiento quirúrgico; la técnica descrita por Broström y modificada por Gould es la más utilizada, efectiva y reportada en la actualidad. Con el advenimiento de la cirugía artroscópica, uno de los autores (JBGG) ha desarrollado una técnica mínimamente invasiva que se ha utilizado en la unidad de pie desde hace 8 años. Este trabajo evalúa los resultados funcionales, de dolor y cicatrización de los pacientes tratados con la técnica Artroscópica y la técnica de Broström-Gould abierta. Materiales & Métodos Se evaluaron un total de 111 pacientes, 50 con la técnica abierta y 61 con técnica artroscópica, operados por inestabilidad lateral crónica del tobillo entre enero de 2004 y diciembre de 2011. Se utilizo la escala AOFAS de tobillo y retropié para la medición del dolor, función y alineación, y la escala EVA para la medición del dolor. Resultados El promedio de puntuación final de la escala AOFAS fue de 90 puntos y la inestabilidad se revirtió en el 96% de los casos, para ambos grupo de pacientes. El dolor fue aliviado eficientemente por ambas técnicas. No se observaron diferencias estadísticamente significativas entre los grupos del estudio. Discusión La reparación artroscópica de la inestabilidad crónica lateral del tobillo fue tan efectiva para restablecer la función, estabilidad y eliminar el dolor del tobillo como la técnica abierta y puede tener una menor posibilidad de complicaciones relacionadas con las heridas.

Background Chronic lateral ankle instability is a common condition in people with inversion sprains. Initial treatment is conservative, and if that does not work a surgical approach is recommended, such as that described by Broström and later modified by Gould, and is the most used and effective. With the advent of arthroscopic surgery, one of the authors (JBGG) has recently developed a minimally invasive technique that has been used in the Surgical Foot and Ankle Unit of Imbanaco Medical Centre for 8 years. Therefore, this work aims to determine functional outcomes of patients treated with the arthroscopic technique compared with the open technique of Broström-Gould. Methods A total of 111 patients were evaluated, including 50 with the open method, and 61 with arthroscopic surgery technique for chronic lateral ankle instability between January 2004 and December 2011. The American orthopaedic foot and ankle score (AOFAS) scale for ankle and hindfoot was used for measuring pain, function, and alignment, and a visual analogue scale (VAS) was used to assess the pain. Results The final AOFAS score was 90 points, and instability was reversed in 96% of cases, for both groups of patients. The pain was relieved efficiently by both techniques. There were no statistically significant differences between the study groups. Discussion Arthroscopic repair of chronic lateral ankle instability is an effective tool to restore the function and stability, as well as eliminate ankle pain, and is comparable in effectiveness with the conventional technique. Additionally, there is a lower chance of complications related to wounds.

Presencia y biometría del os trigonum en individuos chilenos: estudio radiológico / Presence and biometry of the os trigonum in Chilean individuals: radiological study

El tubérculo lateral del proceso posterior del talo se fusiona generalmente con el cuerpo de este hueso, sin embargo, debido al estrés (flexión plantar forzada) aplicado durante los años de la adolescencia o cuando un centro osificado parcialmente e incluso totalmente osificado se fractura, se provoca una falta de unión, dando lugar a un hueso accesorio denominado Os trigonum (OT). En algunos casos puede producirse el síndrome os trigonum o síndrome de pinzamiento posterior, el cual se caracteriza por un dolor agudo o crónico de la región posterior del tobillo. Basado en lo anterior, se realizó un estudio retrospectivo entre el período de Agosto de 2017 a Mayo de 2018, en el cual se analizaron radiografías bilaterales de 205 pacientes concurrentes al Hospital Hernán Henríquez Aravena de Temuco, Chile. De la población estudiada, 154 fueron de sexo femenino y 51 de sexo masculino cuyas edades fluctuaron entre los 15 y 85 años, Las proyecciones radiológicas utilizadas fueron de pie lateral, tobillo lateral o calcáneo lateral, para así para determinar la prevalencia de OT y contribuir acerca de su distribución en pie derecho e izquierdo y aparición según sexo y edad. Del total de la muestra, se encontraron 24 individuos que presentaban OT (11,7 %) de los cuales 18 (75 %) correspondían al sexo femenino y 6 (25 %) al sexo masculino. Además se realizaron mediciones del largo y ancho del OT. Los datos obtenidos son una contribución al conocimiento de los huesos accesorios del pie en la población chilena.

The lateral tubercle of the posterior process of the talus is generally fused with the body of this bone, however, due to stress (forced plantar flexion) applied during the adolescent years. Also, when a partially ossified and even fully ossified center fractures, it causes a lack of union, giving rise to an accessory bone called Os trigonum (OT). In some cases Os trigonum syndrome or posterior impingement syndrome may occur, which is characterized by acute or chronic pain in the posterior region of the ankle. Based on the above, a retrospective study was conducted between August 2017 and May 2018, in which bilateral radiographs of 205 patients attending the Hernán Henríquez Aravena Hospital of Temuco were analyzed. Of the population studied, 154 were female and 51 were male, whose ages fluctuated between 15 and 85 years. The radiological projections used were lateral foot, lateral ankle and calcaneus lateral, to determine the prevalence of OT and provide information about its distribution in right and left foot and appearance according to sex and age. From the total sample, 24 individuals were found who had OT (11.7 %) of which 18 (75 %) corresponded to the female sex and 6 (25 %) to the male sex. In addition, measurements of the length and width of the OT were made. The data obtained is a contribution to the knowledge of the accessory bones of the foot in the Chilean population.

Effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions / 中国修复重建外科杂志

Objective: To investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions. Methods: Between January 2012 and December 2016, 36 patients (36 feet) with ankle diseases underwent tibio-talo-calcaneal arthrodesis with parallel double thread headless compression screws via minimal anterior and lateral oblique incisions. There were 14 males and 22 females with an average age of 53.8 years (range, 18-76 years). There were 19 cases of left feet and 17 cases of right feet. There were 21 cases of talar necrosis, 7 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 2 cases of tuberculosis infection (inactive), 1 case of talar absence, 1 case of Charcot’s disease, and 1 case of pigmented villonodular synovitis of ankle and subtalar joints. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 53.7±2.5 and 5.9±0.2, respectively. The operation time was recorded and the wound healing and complications were observed. The bone healing was assessed by X-ray film and CT scanning. The function and pain of joint were evaluated by AOFAS and VAS scores. Results: The mean operation time was 49.8 minutes (range, 33-82 minutes). Incision infection occurred in 1 patient (2.8%) at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of 18.5 months (range, 12-29 months). Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks (range, 8-15 weeks). After 1 year, the AOFAS score (84.7±0.6) and VAS score (0.3±0.1) were significantly higher than preoperative scores ( t=12.596, P=0.000; t=30.393, P=0.000). Conclusion: It is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle disease because of the less complications incidence and the higher postoperative fusion rate.

Tratamiento de lesión osteocondral del astrágalo con microfractura / Injury treatment with microfracturetalar osteochondral

Se han descrito diversas opciones de tratamiento de la lesión osteocondral del domo del Astrágalo de acuerdo al tamaño y ubicación de la misma, el propósito de este trabajo es evaluar los resultados del tratamiento de esta lesión, con microfractura, vía artroscópica, sin importar el tamaño ó ubicación de la misma. Se realiza un análisis retrospectivo de los pacientes con lesión osteocondral del domo astragalino, tratados con microfractura vía artroscópica, realizadas entre agosto 2005 y enero 2014. Se evaluó escala de dolor (VAS), satisfacción del paciente y tamaño de la lesión, dividiéndose en 2 grupos: pacientes con lesiones menores a 20 mm y pacientes con lesiones igual ó mayores a 20 mm. Se intervinieron 46 pacientes, con edad promedio 37 años (19-49), el tiempo promedio de seguimiento,17,6 meses (6-32 meses). La escala de dolor (VAS) en el preoperatorio en los pacientes con lesiones menores a 20 mm, fue 7,8 (4 a 9) y el postoperatorio 1,6 (0 a 4);2 ameritaron nueva microfractura. 11 pacientes presentaron lesiones igual ó mayores a 20 mm, el VAS preoperatorio fue 8,2 (6 a 9) y 2,6 (1 a 6) el postoperatorio, 3 ameritaron otro procedimiento, 1 nueva microfractura y 2 mosaicoplastia. Si bien es cierto que la evidencia científica ha demostrado que la microfractura es el tratamiento más efectivo y menos invasivo en lesiones pequeñas, en nuestro estudio evidenciamos, que un alto porcentaje de pacientes con lesiones iguales ó mayores a 20 mm, también pueden beneficiarse de este tratamiento, evitando la realización de procedimientos más invasivos y las potenciales complicaciones asociados a estos; por lo tanto, la microfractura artroscópica, es nuestra primera opción de tratamiento en esta lesión(AU)

There has been a described diverse option of treatment for talar dome dome osteocondral lesions, depending on the lesion size and placement. The purpose of this study, is to evaluate the results of microfracture of this lesion, despite the size and lesion placement. Retrospective analysis was performed of patients with talar dome osteochondral lesion, treated with arthroscopic microfracture by the same surgeon, at Hospital de Clínicas Caracas between august 2005 and January 2014. Visual analog scale (VAS), patient satisfaction and lesion size was evaluated, dividing it in 2 groups, lesion size smaller than 20 mm and lesion size equal or bigger than 20 mm.46 patients with talar dome ostreochondral lesion had surgery in the perios of time studied, with an average age of 37 years (19-46), 39 patients Could be followed up one year postop, the mean following time was 17,6 months (6-32). The VAS preop in the 28 patients with lesions smaller than 20 mm was 7,8 (4 to 9) and postop 1,6 (0 to 4), 2 patients needed new microfracture. 11 patients had lesion equal or bigger than 20 mm, preop VAS was 8,2 (6 to 9) and postop 2,6 (1 to 6). 3 needed a new procedure, 1 microfracture and 2 mosaicplasty. Talar dome ostechondral lesions treatment is a great Challenger. Although scientific evidence has shown that microfracture is the less invasive and most effective treatment for small lesions, in our study we showed that a high percent of patients with lesions equal or bigger than 20 mm may Benedit from this treatment, avoiding more invasive procederes and its potencial complications, so microfracture is the first treatment option for the lesion, despite the size and lesion location(AU)

The Talus-1st Metatarsal Angle, the Talo-Horizontal Angle and Calcaneal Pitch Angle of Young Men in Korea / 대한족부족관절학회지

PURPOSE: The purpose of this study is to find out the normal angles of the talus-1st metatarsal angle, the talo-horizontal angle and calcaneal pitch angle for diagnosis of foot deformity in Korea. This would be helpful as it would provide a basic angular measurement of flat and cavus foot that indicates the need for operation. MATERIALS AND METHODS: Within a period of four months from January 2007 to April 2007, We have established 600 feet of 300 males without trauma history of foot. The source to image distance is 40 inches and erect weight bearing radiographs are obtained in anteroposterior and lateral projections. The significant angular measurements that define flat or cavus foot are the talus-1st metatarsal angle, the talo-horizontal angle and calcaneal pitch angle. RESULTS: The mean age was 21 years (19-22 years) old. The mean talus-1st metatarsal angle was 0+/-6.9degrees, the mean talo-horizontal angle was 25.8+/-4.5degrees and the mean calcaneal pitch angle was 23.9+/-5.1degrees. CONCLUSION: We can consider that mean talus-1st metatarsal angle, talo-horizontal angle and calcaneal pitch angle are 0+/-6.9degrees, 25.8+/-4.5degrees and 23.9+/-5.1degrees as an normal angle limit of young age in Korea.

CARACTERIZACIÓN DEL TALLO ACEPTOR DEL tARN MEDIANTE DESCRIPTORES LOCALES BASADOS EN CARGAS PARCIALES / tRNA ACCEPTOR STEM CHARACTERIZATION BY MEANS OF LOCAL DESCRIPTORS BASED ON PARTIAL CHARGES / CARACTERIZAÇÃO DO TALO ACEITADOR DO tRNA MEDIANTE DESCRITORES LOCAIS BASEADOS EM CARGAS PARCIAIS

En este trabajo se caracteriza la distribución de carga del tallo aceptor del tARN, considerando todas las posibles combinaciones de pares Watson-Crick. El estudio se realizó con 256 fragmentos moleculares de 10 nucleótidos que modelan los tres primeros pares del tallo aceptor, la base diferenciadora y el extremo CCA. Para caracterizar los nucleótidos se proponen dos descriptores locales basados en la distribución de carga de la base nitrogenada de cada nucleótido, los cuales se calculan a partir de las cargas parciales de Mulliken obtenidas de cálculos HF/6-31G. La caracterización y clasificación de los tallos según estos descriptores mostró cómo la base diferenciadora tiene un comportamiento particular respecto a los demás nucleótidos del tallo y una fuerte influencia sobre el extremo CCA. La clasificación de nueve variaciones del tallo aceptor del tARNAla mostró una buena relación estructura-actividad que pone en evidencia la bondad de los descriptores propuestos para caracterizar de manera local la distribución de carga de estas biomoléculas.

In this work the charge distribution of the tRNA acceptor stem is characterized, considering all the possible Watson- Crick base pair combinations. 256 RNA fragments modeled by 10 nucleotides were used in order to model the first three pairs of the acceptor stem, the discriminator base and the CCA end. We propose two local charge descriptors based on the charge distribution of the nitrogenated base to characterize each nucleotide. These descriptors were computed from atomic partial charges derived from HF/6-31G calculations. From the characterization and classification of the stems according to the proposed descriptors, we found a special behavior for the discriminator base (in contrast to the other positions) and a strong effect of this position on the CCA end. The classification of nine variations of the tRNAAla acceptor stem showed a good structure-activity relationship that makes evident the usefulness of the proposed descriptors to characterize the local charge distributions of these biomolecules.

Nesse estudo é caracterizada a distribuição da carga do talo aceitador considerando- se todas as combinações possíveis dos pares Watson-Crick. O estudo realizouse com 256 fragmentos moleculares dos 10 nucleotídeos que modelam os três primeiros pares do talo aceitador, a base diferenciadora e o extremo CCA. Com o intuito de caracterizar cada nucleotídeo, foram propostos dois descritores locais baseados na distribuição de carga da base nitrogenada de cada nucleotídeo, os quais se calculam a partir das cargas parciais de Mulliken obtidas de cálculos HF/6-31G. A caracterização e classificação dos talos segundo esses descritores demonstrou um particular comportamento da base diferenciadora em relação aos demais nucleotídeos do talo e uma forte influência sobre o extremo CCA. A classificação de nove variações do talo aceitador do tRNA mostrou uma boa relação estrutura-atividade que colocam em evidência a utilidade dos descritores propostos para caracterizar de maneira local a distribuição de carga dessas bio-moléculas.

Tibio-talo-calcaneal Arthrodesis with Multiple Cannulated Screw Fixation / 대한족부족관절학회지

PURPOSE: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. MATERIALS AND METHODS: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. RESULTS: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. CONCLUSION: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.