Comparison of the effectiveness of two kinds of surgeries for treatment of flexible flatfoot combined with painful accessory navicular bone in children / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of subtalar arthroereisis (STA) combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children.@*METHODS@#The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed. They were divided into a combination group (17 cases, treated by STA combined with modified Kidner procedure) and a control group (16 cases, treated by STA alone) according to the surgical methods. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, affected side of the foot, disease duration, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talonavicular coverage angle (TCA), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle), and heel valgus angle (HV). The operation time, incision length, intraoperative blood loss, number of intraoperative fluoroscopies, and perioperative complications were recorded in both groups. The anteroposterior, lateral, and calcaneal axial X-ray films for the affected feet were taken regularly, and T1MT, T2MT, TCA, Meary angle, Pitch angle, and HV were measured. The VAS score, AOFAS ankle-hindfoot score were used to evaluate pain and functional recovery before and after operation.@*RESULTS@#Surgeries in both groups were successfully performed without surgical complication such as vascular, nerve, or tendon injuries. Less operation time, shorter incision length, less intraoperative blood loss, and fewer intraoperative fluoroscopies were found in the control group than in the combination group ( P<0.05). One case in the combination group had partial necrosis of the skin at the edge of the incision, which healed after the dressing change and infrared light therapy, and the rest of the incisions healed by first intention. All children were followed up 12-36 months, with a mean of 19.6 months. At last follow-up, VAS score and AOFAS ankle-hindfoot score significantly improved in both groups when compared with preoperative ones ( P<0.05), and the differences of these scores between before and after operation improved more significantly in the combination group than in the control group ( P<0.05). Imaging results showed that the T1MT, T2MT, TCA, Meary angle, and HV significantly improved in both groups at last follow-up when compared with preoperative ones ( P<0.05), and the Pitch angle had no significant difference when compared with preoperative one ( P>0.05). But there was no significant difference in the difference of these indicators between before and after operation between the two groups ( P>0.05).@*CONCLUSION@#Both procedures are effective in the treatment of flexible flatfoot children with painful accessory navicular bone. STA has the advantage of minimally invasive, while STA combined with modified Kidner procedure has better effectiveness.

Um teste clínico randomizado comparando o fortalecimento de abdutores do quadril e terapia manual em pacientes com fascite plantar: um protocolo de estudo / A randomized clinical trial comparing hip abductors strengthening and manual therapy in patients with plantar fasciitis: a study protocol

| INTRODUÇÃO: A fascite plantar (FP) é uma causa comum de dor no calcanhar e deformidade da articulação do tornozelo. Mais de 11% -15% da população com sintomas nos pés precisa de cuidados de longo prazo. Foi comprovado que várias intervenções de fisioterapia com terapia convencional, que inclui terapia manual, ajudam nessa condição. OBJETIVO: Avaliar o efeito do fortalecimento do abdutor do quadril e da terapia manual (MT) em paciente com fascite plantar (FP). MÉTODOS: O desenho do estudo será um ensaio de controle randomizado de dois grupos, pré-teste e pós-teste. Um total de 30 participantes do sexo masculino e feminino com idade acima de 18-60 anos com dores provocadas pelos primeiros passos da manhã, dor na região plantar do calcanhar, serão alocados aleatoriamente em dois grupos - o Grupo A receberá terapia manual (TM) com fisioterapia convencional enquanto o Grupo B receberá fortalecimento dos abdutores do quadril com fisioterapia convencional. Ambos os grupos receberão 16 sessões de tratamento por 4 dias em cada semana durante 4 semanas. "Foot Function Index", "Podia scan", "Teste de queda do navicular" serão usados como medida de desfecho e serão avaliados na 1ª semana e na 4ª semana de tratamento em ambos os grupos. CONCLUSÃO: Os pacientes que recebem a intervenção de fortalecimento do abdutor do quadril podem ter resultados positivos quando comparados à intervenção de MT entre pacientes com FP. Este será o primeiro estudo a comparar o efeito do fortalecimento dos abdutores do quadril e da terapia manual. REGISTRO DE ENSAIO: Registro de Ensaios Clínicos - Índia. (CTRI / 2020/04/024541)

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%- 15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE: To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group PretestPosttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. "Foot function index," "Podiascan," "Navicular drop test" will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. This will be the first study to compare the effect of hip abductors strengthening and manual therapy. TRIAL REGISTRATION: Clinical Trial Registry- India. (CTRI/2020/04/024541)

Outcome of modified Kidner procedure with tendoscopy for the treatment of painful accessory navicular / 中国骨伤

OBJECTIVE@#To evaluate clinical efficacy of modified kidner procedure with tendoscopy in treating painful accessory navicular.@*METHODS@#From February 2014 to April 2019, 19 patients with painful accessory navicular were admitted, including 13 males and 6 females with a mean age of 26 years old (ranged from 14 to 58 years old), all of which were unilateral symptoms. The courses of disease ranged from 6 to 60 months. All patients received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor, and the tendoscopy were used to examin the posterior tibial tendon. American Orthopedic Foot and Ankle Society(AOFAS) midfoot score and visual analogue scale(VAS) were used to evaluate efficacy before operation and at the latest follow-up.@*RESULTS@#All the patientswere followed up, and the duration ranged from 12 to 73 months, with an average of (35.0±20.9) months. VAS score was 0.20±0.41 at the latest follow-up, showing significant difference when compared with preoperative score of 6.33±1.95(@*CONCLUSION@#The modified kidner procedure with tendoscopy is a good choice for the treatment of painful accessory navicular, which could obviously relieve foot pain, improve foot function, and has certain clinical efficacy.

Simple HyProCure subtalar stabilization in treatment of adolescent flexible flatfoot combined with painful accessory navicular bone / 中国组织工程研究

BACKGROUND: HyProCure subtalar stabilization has been widely used in the treatment of flexible flatfoot, but there is no unified treatment for adolescent flexible flatfoot with painful accessory navicular bone. OBJECTIVE: To evaluate the effectiveness of HyProCure subtalar stabilization for adolescent flexible flatfoot combined with painful accessory navicular bone. METHODS: Between January 2015 and September 2019, 24 cases (39 feet) of adolescent flexible flatfoot combined with painful accessory navicular bone were treated with HyProCure subtalar stabilization in National Rehabilitation Hospital. There were 13 males (22 feet) and 11 females (17 feet) with the age of 5-15 years. Visual analogue scale score and American Orthopaedic Foot & Ankle Society (AOFAS) ankle and foot function score were used to evaluate the effectiveness. The talus-the first metatarsal angle (Meary’s angle), the talus-the second metatarsal angle, calcaneal inclination angle (Pitch angle), the talar declination angle, calcaneal valgus angle, talonavicular coverage angle, and talocalcaneal angle were measured on the X-ray films. This study was approved by the Ethics Committee of National Rehabilitation Hospital. RESULTS AND CONCLUSION: (1) All incisions of 24 patients healed well in the first stage. Two cases (2 feet) had tarsal sinus pain; one case (1 foot) appeared with mild hindfoot varus and insufficient weight-bearing under the 1st metatarsal head, also one case (1 foot) complained mild painful remain at local site. (2) All 24 patients were followed up for 6-36 months. No case suffered from hardware failure or hardware removal. (3) At last follow-up, visual analogue scale score was significantly decreased compared with that before surgery (P < 0.01); AOFAS ankle and foot function score was significantly increased compared with that before surgery (P < 0.01). (4) At last follow-up, Meary’s angle, the talus-the second metatarsal angle, Pitch angle, the talar declination angle, calcaneal valgus angle, talonavicular coverage angle, and talocalcaneal angle in 24 patients were significantly improved compared with that before surgery (P < 0.01 or P < 0.05). (5) The results suggested that HyProCure subtalar stabilization is effective for adolescent flexible flatfoot combined with painful accessory navicular bone in short term.

Application of modified internal fixation and fusion for type Ⅱ painful accessory navicular in adults / 中国修复重建外科杂志

Objective: To explore the effectiveness of modified internal fixation and fusion in treatment of type Ⅱ painful accessory navicular (PAN) in adults. Methods: Between January 2016 and December 2017, 29 patients (37 feet) with type Ⅱ PAN were treated with modified internal fixation and fusion. There were 12 males and 17 females with an average age of 41.4 years (range, 18-50 years). The injury caused by sprain in 24 cases and no obvious inducement occurred in 5 cases. All patients received conservative treatment for more than 6 months with no significant improvement. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score before operation and at last follow-up. The inclination angle of calcaneus, the first metatarsal angle of talus, the inclusion angle of talonavicular joint, and the second metatarsal angle of talus were measured on X-ray films. Results: Superficial infection of incision occurred in 1 case after operation, and the incision healed after enhanced dressing change. The incisons of the other patients healed by first intention. There was no deep infection or osteomyelitis. All patients were followed up 12-33 months (mean, 25.1 months). X-ray films showed that the articular surfaces healed at 2-5 months after operation, with an average of 3.4 months. No loosening or rupture of internal fixator was found during the follow-up. At last follow-up, the pain, function, alignment scores, and total score of AOFAS were significantly improved when compared with those before operation (P<0.05). The inclusion angle of talonavicular joint, the first metatarsal angle of talus, and the second metatarsal angle of talus were also significantly improved when compared with those before operation (P<0.05). But there was no significant difference in the inclination angle of calcaneus between pre- and post-operation (t=1.097, P=0.276). Conclusion: Modified internal fixation and fusion in treatment of type Ⅱ PAN can effectively relieve the symptoms and obtain good recovery of feet function with less complications.

Clinical study of transverse island fasciocutaneous fascia flap for treatment of meatus and navicular fossa stricture / 中华泌尿外科杂志

Objective To investigate the clinical effect of transverse island fasciocutaneous penile flap in the treatment of meatus and navicular fossa stricture.Methods Fifteen patients with urethral reconstruction with transverse island fasciocutaneous penile flap from October 2014 to December 2018 were enrolled.Six patients had a history of urethroscopic surgery,three had a history of lichensclerosus,three had a history of urethral dilation,and three had no obvious causes.All patients underwent transverse incision under the coronal sulcus,and after fully dissecting the urethra,the urethra was opened longitudinally ventrally.After measuring the actual length of stenosis,the irradiance fascia flap with the corresponding length of the incision was reconstructed.The patients were reviewed at 1 and 3 months after operation,and any complications such as recurrence or urinary fistula were recorded.The urine flow rate was tested 3 months after surgery.Results All 15 patients in this group underwent a successfully operation.The actual measurement of urethral stricture length was 0.5-4.0 cm during operation,with the average of 2.82 cm.Three months after the operation,the urine flow rate ranged from 13.5 ml/s to 23.7 ml/s,with an average of 18.5 ml/s.The overall successful rate was 93.3％ (14/15).The rate of post-operative fistula was 20.0％ (3/15).Two cases complained of needle-like fistula at the incision.One case healed after 3 months,and the other gave up further treatment.One patient developed urethral stricture and urethral skin spasm again 1 month later and was surgically repaired again.Conclusions The initial experience of pedicled island fascia flap for the treatment of urethral stenosis and scaphoid stenosis is safe,feasible and effective for the treatment of urethral stricture.

Influence of Longitudinal Arch of Foot on the Strength and Muscle Activity of the Abductor Hallucis in Subjects with and without Navicular Drop Sign

PURPOSE: This study examined the influence of longitudinal arch on the strength and muscle activity of the abductor hallucis in the standing position in subjects with and without navicular drop signs. METHODS: A sample of 34 subjects with and without navicular drop signs between 22 and 28 years of age were enrolled in this study. The strength and muscle activity of the abductor hallucis was measured using a tensiometer. The Smart KEMA System and electromyography device was used on the subjects with and without navicular drop signs. Two groups were classified using the navicular drop test to identify the longitudinal arch of the foot. The strength of the abductor hallucis was evaluated in standing, both with and without an external arch support condition. The two-way mixed ANOVA was used. The level of statistical significance was set to α=0.05. RESULTS: The strength and muscle activity of the abductor hallucis in standing was significantly higher with external arch support than that without the external arch support in the group with navicular drop signs. There was no significant difference in the abductor hallucis strength and muscle activity with and without external arch support in the subjects without navicular drop signs. CONCLUSIONS: The strength and muscle activity of the abductor hallucis in standing can be influenced by the external arch support in the group with navicular drop signs. The strength measurement of the abductor hallucis in standing should be separately performed in conditions with and without longitudinal arch of foot.

Evaluation of Accessory Navicular Bone Using a Bone Scan and Its Clinical Significance for the Prognosis and Treatment / 대한족부족관절학회지

PURPOSE: To evaluate the clinical significance and usefulness of a bone scan in accessory navicular bone. MATERIALS AND METHODS: Eighty-five patients with foot pain and accessory navicular bone on radiography, who underwent bone scan from 2012 to 2015, were analyzed retrospectively. The subjects was divided into a symptomatic and asymptomatic group according to the presence of navicular bone tenderness. The grade of bone scan uptake was divided into 3 grades. Age, gender, grade of bone scan and size of the accessory navicular bone were analyzed. The symptomatic group were divided into a low (grade 0, 1) and high uptake (grade 2) group to determine the appropriate treatment. The low uptake group was treated conservatively for 3 months. The high uptake group was initially treated conservatively for 3 months and surgery was performed if pain persisted. For the clinical evaluation, the visual analogue scale, American Orthopaedic Foot and Ankle Society midfoot scale were evaluated in the first examination and last follow-up date. The patient's satisfaction grade was also evaluated at the last follow-up. RESULTS: The asymptomatic group mostly showed no uptake in the bone scan. On the other hand, some patients in the asymptomatic group showed an increase in uptake. In these patients, the size of accessory navicular bone was related to the grade of bone scan uptake, showing that the bone scan uptake grade can be predicted when applying different cut off values for the bone size. The symptomatic group mostly showed uptake in the bone scan and the grade of uptake had a positive correlation with the size of the accessory navicular bone (p<0.05). Age and gender were not related to the bone scan uptake. In the clinical evaluation, conservative and surgical treatment showed a good outcome. CONCLUSION: The bone scan uptake grade alone cannot be used to completely predict the symptoms. On the other hand, the size of the accessory bone can increase the bone scan uptake. Therefore, the size of the accessory bone, and patient symptoms should be considered in patients with a high uptake when deciding treatment.

Estudo anatômico, ultrassonográfico e tomográfico do aparato podotroclear de equinos adultos / Anatomic, tomographic and sonographic study of podotrochlear apparatus of adult horses

A síndrome do navicular é uma condição que envolve o aparato podotroclear e representa uma das causas mais comuns de claudicação dos membros torácicos de equinos. Portanto, o estudo complementar da região reveste-se de grande interesse quando se refere ao diagnóstico e tratamento das claudicações dos equinos. O objetivo deste estudo foi demonstrar as diferenças dos achados imagenológicos entre a ultrassonografia e a tomografia computadorizada na avaliação das estruturas palmares do aparato podotroclear de equinos adultos e hígidos, bem como a descrição das estruturas observadas nas imagens obtidas com essas técnicas. Para isso, foram realizadas imagens de quatro peças anatômicas, as quais foram posteriormente seccionadas e utilizadas para a descrição anatômica. A utilização de peças anatômicas auxilia no conhecimento da anatomia normal, o que leva à melhor interpretação das imagens e aumenta a especificidade diagnóstica na detecção das alterações que as doenças acarretam. A ultrassonografia fornece informações relevantes quanto às estruturas estudadas, e sua associação com a tomografia computadorizada aumentou a acurácia da investigação. Apesar de o uso da tomografia computadorizada ser mais indicada para tecido ósseo, ela fornece informações importantes, podendo ser usada como uma ferramenta útil quando não se tem disponível a ressonância magnética em razão do custo ou da disponibilidade.(AU)

The navicular syndrome is a condition involving the podotrochlear apparatus and represents one of the most common causes of forelimb lameness in horses. Therefore, further study of this region is of interest when it comes to diagnosis and treatment of lameness in horses. The aim of this study was to demonstrate the differences between the imaging findings of ultrasonography and computed tomography in the evaluation of the palmar structures of the podotrochlear apparatus of healthy adult horses and description of the structures observed in images obtained with these techniques. For this, four images of four anatomical parts were performed, and subsequently sectioned and used for the anatomical description. The use of anatomical parts helps in the understanding of normal anatomy leading to a better interpretation of the images and increasing the specificity of the diagnostic for detecting changes that cause diseases. Ultrasonography provides relevant information about these structures to be studied and the association with computed tomography (CT) increased the accuracy of the investigation. Despite the use of CT being more suitable for bone tissue it provides important information and can be used as a useful tool when there is no available MRI.(AU)

Response of three digital anesthetic technics in horses with forelimb hoof lameness / Resposta de três técnicas anestésicas digitais em equinos com claudicação dos membros anteriores ligada ao casco

The presented study aimed to assess objectively the response of distal interphalangeal joint (DIJ), navicular bursa (NB) and deep digital flexor tendon sheath (DDFTS) anesthesia in horses with forelimb hoof lameness; and evaluate if the presence of radiographic abnormalities on navicular bone could interfere on blocks' results. Fifteen horses with lameness improvement above 70% after palmar digital nerve (PDN) block were selected for this study. Blocks were assessed separately on five consecutive trials at seven different time-points. The fifth trial was performed to evaluate the influence of exercise on preexisting lameness. Most of horses (73.33%) presented pain related to the podotrochlear apparatus based on clinical and lameness exam and blocks' responses. NB and DIJ anesthesia differed on the frequency of horses with lameness improvement above 70% only at 10min (p=0.03), and both differed from DDFTS block until 30'(p<0.05). The blocks' response was variable along the time and the highest means for NB, DIJ and DDFTS were observed at 5-10 minutes ('), 15-20' and 10-15' respectively.Exercise had low interference on lameness intensity since no improvement above 50% was observed and an increase on lameness intensity over time was identified in seven horses. Variable grades of navicular bone radiographic lesions were observed in 14 horses, although these lesions had no interference on blocks' response (p>0.05). The NB and DIJ blocks had similar responses and both were superior to DDFTS anesthesia, coincident with a major prevalence of podotroclear apparatus abnormalities in this equine population.(AU)

O presente estudo avaliou, de forma objetiva, as respostas do bloqueio da articulação interfalangeana distal (AID), da bursa do navicular (BN) e da bainha do tendão flexor digital profundo (BTFDP) em equinos com claudicação ligada ao casco nos membros torácicos; além de analisar a influência das alterações radiográficas do osso navicular no resultado dos bloqueios. Quinze cavalos, que apresentaram uma melhora da claudicação acima de 70% após o bloqueio do nervo digital palmar, foram selecionados para este estudo. Os bloqueios foram avaliados separadamente em cinco turnos consecutivos e em sete tempos diferentes. O quinto turno foi utilizado para analisar a influência do exercício sobre a claudicação preexistente. A maioria dos cavalos (73,33%) apresentou dor relacionada à porção palmar do casco, com base nos achados do exame clínico em movimento e nas respostas dos bloqueios. As anestesias da BN e da AID apresentaram diferença quanto à frequência de cavalos com melhora da claudicação acima de 70% apenas aos 10min (p=0.03), e ambos diferiram do bloqueio da BTFDP até os 30min (p<0.05). A resposta dos bloqueios foi variada ao longo do tempo, e as maiores médias de melhora da claudicação para os bloqueios BN, AID e BTFDP foram observadas aos 5-10min, 15-20min e 10-15min, respectivamente. O exercício teve pequena interferência na intensidade da claudicação, uma vez que nenhuma melhora acima de 50% foi observada e sete cavalos aumentaram a intensidade da claudicação ao longo do tempo. A presença de diferentes graus de lesão radiográfica do osso navicular foi observada em 14 cavalos, porém essas lesões não interferiram na resposta dos bloqueios (p>0,05). Os bloqueios da BN e da AID apresentaram respostas semelhantes, e ambos foram superiores ao bloqueio da BTFDP, coincidindo com uma marcada prevalência de doença do aparato podotroclear nesta população de equinos.(AU)

Revision Surgery for Recurrent Pain after Excision of the Accessory Navicular and Relocation of the Tibialis Posterior Tendon

BACKGROUND: The results of operative treatments for symptomatic accessory navicular are debatable. In some cases, recurrent pain may develop after the Kidner procedure. The purpose of this study is to review the reasons for recurrent pain after the Kidner procedure and to suggest possible options for revision surgery. METHODS: We reviewed the clinical and radiological outcomes in 9 patients who underwent revision surgery for recurrent pain after the Kidner procedure. During the revision surgery, the tibialis posterior tendon was reattached to the navicular either by advancing the tendon in 4 patients or by lengthening the tendon in another 4 patients. In the other 1 patient, the flexor digitorum longus tendon was transferred. Surgeries for the accompanying deformities were performed simultaneously in all patients. The results were evaluated using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and a visual analog scale. The mean follow-up was 2.3 years (range, 1 to 5 years). RESULTS: The mean American Orthopedic Foot and Ankle Society ankle-hindfoot score improved from 71.25 to 81.50 in the advancement group, and 71.75 to 90.00 in the lengthening group. The mean visual analog scale improved from 7.75 to 4.25 in the advancement group and from 7.50 to 1.75 in the lengthening group. CONCLUSIONS: Recurrent pain after the Kidner procedure was associated with pes planovalgus or hindfoot valgus deformity. In revision surgery, correction of the associated deformities and reattachment of the tibialis posterior tendon after lengthening may need to be considered.

Vascular foramina of navicular bone: a morphometric study / 대한해부학회지

The navicular bone is supplied by more than one artery. The knowledge about the vascular foramina is important to understand the pathogenesis and management of navicular fractures. The objective of the present study is to analyze the morphology and morphometry of vascular foramina of dried human navicular bone in Indian population. The study was carried out by using 100 navicular bones (50 right and 50 left) collected from our institute and other medical institutes in and around Puducherry. The bones were macroscopically studied for vascular foramina with respect to its location, number, size, and shape. The data collected were statistically analyzed. The vascular foramina were present on dorsal, plantar, medial, and lateral surfaces of navicular bone. Kruskal-Wallis test followed by series of Mann-Whitney test for post hoc analysis showed the number of nutrient foramina observed on dorsal surface were significantly greater than those observed on the plantar (U=2,755, P=0.001), medial (U=43, P=0.001), and lateral (U=626.5, P=0.001) surfaces of the navicle. About 97.6% of foramina were circular and 2.5% were oval in appearance. About 96.7% of vascular foramina were <1 mm in size and 3.3% were ≥1 mm in size. Spearman's rank correlation coefficient done showed a strong, positive correlation between vascular foramina of <1 mm size and circular shape, which was statistically significant (r(s)=0.981, P=0.001). We believe the present study has provided additional information on the vascular foramina of navicular bone and useful to surgeons in foot surgeries.

Short-Term Results of a Modified Kidner Procedure Using a Suture Bridge Technique for Symptomatic Type II Accessory Navicular / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the clinical outcome of a modified Kidner procedure using a suture bridge technique in symptomatic type II accessory navicular. MATERIALS AND METHODS: Between January 2013 and December 2014, a total of 35 cases with symptomatic type II accessory navicular were treated with a modified Kidner procedure using the suture bridge technique. The patients were evaluated preoperatively, 3 months after surgery, and at the latest follow-up (at least six months postoperatively) clinically via the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS), and the self-subjective satisfaction score. RESULTS: The mean AOFAS midfoot score demonstrated significant improvement from a mean of 45.3 preoperatively to a mean of 89.2 at 3 months after surgery. At the latest follow-up, the mean AOFAS midfoot score was 92.6 (p<0.001). The mean VAS also improved significantly, decreasing from 6.7 out of 10 preoperatively to 1.8 at 3 months after surgery. At the latest follow-up, the VAS was 1.2 (p<0.001). The mean time of a single-limb heel raise was 4.6 months postoperatively and the self-subjective satisfaction score was 1.4 out of 4 at the latest follow-up. CONCLUSION: The short-term surgical results of the modified Kidner procedure with a suture bridge technique for symptomatic type II accessory navicular were good to excellent in terms of pain, functional and clinical assessments. In conclusion, the modified Kidner procedure with the suture bridge technique is a reasonable treatment option for symptomatic type II accessory navicular.

The Operative Management of Navicular Stress Fractures in Adolescence / 대한족부족관절학회지

PURPOSE: The aim of this study is to evaluate the effectiveness of surgical treatment in adolescent patients suffering from navicular stress fracture. MATERIALS AND METHODS: A total of 11 adolescent patients aged 14 to 19, who underwent an operation for navicular stress fracture between 2005 and 2008 were recruited. Clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) score. RESULTS: The mean VAS score before the operation was 7.7. A score of 2.9 was confirmed at final follow up after the operation. The mean final follow-up period was 22.1 months. There was a statistically significant improvement in the VAS score between before and after the operation (p=0.01), and similarly, the AOFAS score also showed an improvement, from 46.5 to 80.7 (p=0.01). The pain that remained after the operation, according to the VAS score, was severe in three patients (27.3%), tolerable in seven patients (63.6%), and free of pain in one patient (9.1%). CONCLUSION: In navicular stress fracture in adolescents, careful selection of patients who could benefit from surgical treatment is recommended.

Fractures of the Tarsal Bone

Fractures of the tarsal bone, such as the navicular, cuboid, and cuneiform, are very rare. These injuries can lead to serious walking difficulties due to pain and deformity of the foot with delayed diagnosis of tarsal bone fractures during an injury to multiple lower extremities. The diagnosis can be done on simple radiographs. Sometime weight bearing radiographs or stress radiographs may be needed for further evaluation. Computed tomography is the most widely available diagnostic tool. Navicular and cuneiform account for the medial column of the foot, whereas cuboid for the lateral column. The treatment of tarsal bone fractures is primarily conservative management, but operative treatment is recommended for intra-articular displacement, dislocation, or shortening of the medial or lateral column of the foot. The operative treatments include screw fixation, plate fixation, or external fixation. Complications include malunion, nonunion, posttraumatic arthritis, avascular necrosis, and deformity of the foot. Tarsal bone fracture has to be evaluated carefully to prevent serious complications.

Características planimétricas y estereológicas de los nervios palmar lateral y medial en manos de equinos con y sin síndrome navicular / Planimetric and stereological characteristics of lateral and medial palmar nerves in hands of equine with and without navicular syndrome

El Síndrome Navicular (SN) es una de las patologías claudicógenas mas frecuentes en la práctica clínica equina. Se ha descrito, cierta susceptibilidad individual respecto a ésta presentación clínica, es decir, algunos equinos con SN claudican y otros, con similares hallazgos radiográficos en mano no lo hacen sugiriendo que existen diferencias cuantitativas, entre equinos con y sin SN, en las características de las fibras nerviosas de los nervios periféricos que inervan la mano. El objetivo del estudio fue describir las características morfológicas cuantitativas de los nervios palmar lateral y medial en equinos con SN. Se obtuvo manos mediante un muestreo dirigido y diagnosticadas por inspección visual y evaluación radiográfica. Se conformó dos grupos: "No afectadas" (n= 6) y "Síndrome Navicular" (n= 8). Para determinar diferencias cuantitativos entre ambos grupos se realizó: i) Estudio 1, evaluó las características morfológicas, planimétricas y estereológicas de los nervios palmar lateral y medial, ii) Estudio 2: evaluó la cantidad de axones mielinizados y no mielinizados. En ambos estudios, el análisis de los datos morfológicos, estereológicos y planimétricos, en general, no detectó diferencias significativas entre grupos. En conclusión, los resultados obtenidos en el estudio no entregan evidencia morfológica respecto a diferencias entre nervios palmares entre equinos con y sin SN.

Navicular Syndrome (NS) is one of the most frequent claudicogen pathologies in the equine clinical practice. Certain individual susceptibility has been described in this clinical presentation, that is, some horses with SN halt, while others with similar radiographic findings in hand do not, suggesting that there are quantitative differences, between horses with and without clinical presentation of SN, on the characteristics of the nerve fibers of the peripheral nerves of the hand. The aim of this study was to describe the morphologic quantitative characteristics of the lateral and medial palmar in horses with SN nerves. Hands were obtained by sampling directed and diagnosed by visual inspection and radiographic evaluation. Two groups were formed: "Not affected" (n= 6) and "Navicular Syndrome" (n = 8). To determine quantitative differences between two groups we performed: i) Study 1: evaluated the morphological, planimetric and stereological lateral and medial palmar nerves, ii) Study 2: evaluated the number of unmyelinated and myelinated axons. In both studies, analysis of stereological, morphological and planimetric data generally detected no significant differences between groups. In conclusion, the results of the study do not provide morphological evidence for differences between palmar nerves between horses with and without SN.

Alterações radiográficas do aparato podotroclear de equinos da Polícia Militar de Minas Gerais sem sinais clínicos de doença do osso navicular / Radiographic changes in the podotroclear apparatus from Minas Gerais State Military horses without clinical signs of navicular disease

Os objetivos deste experimento foram identificar e associar alterações radiográficas do aparato podotoclear de equinos do Regimento de Cavalaria Alferes Tiradentes da Policia Militar do estado de Minas Gerais sem histórico e sinais clínicos de doença do osso navicular. Foi avaliado um total de 33 equinos, de ambos os sexos, com idade entre 10 e 20 anos. Os dígitos torácicos foram radiografados de forma padronizada nas projeções lateromedial (LM), dorsoproximal palmarodistal 65º (DPPD) e palmaroproximal palmarodistal (SK). A radiopacidade medular aumentada em projeção SK foi a principal alteração radiográfica detectada. Essa alteração foi associada a maior número de invaginações sinovais, a maior espessura de cortical em relação à medular em exposição SK e a maior relação corticomedular em exposição LM (P<0,05). Esses achados indicam uma predisposição da população equina para desenvolver a síndrome do osso navicular, possivelmente associada ao trauma repetitivo promovido pelo constante trabalho em piso duro.

The aims of this study were to identify and associate radiographic changes of podotoclear apparatus in horses from the Tiradentes Calvary Regiment of the Military Police of Minas Gerais State without history and clinical signs of navicular disease. 33 horses from both sexes, aged between 10 and 20 years were evaluated. The thoracic digits were radiographed in a standardized manner in lateralmedial (LM), palmaroproximal-distodorsal 65o(DPPD) and palmaroproximal-distopalmar (SK) projections. The increased medullary radiopacity in SK projection was the main radiological change detected and was associated with a higher number of synoval invaginations, increased cortical thickness in relation to medulla in SK exposure and increased corticomedullar in LM exposure (P < 0.05). These findings indicate a predisposition of this population to develop navicular syndrome, which is possibly associated with repetitive trauma promoted by constant work on hard floors.

Estudio histoquímico de la distribución de las fibras de colágeno en hueso sesamoídeo distal de equinos con y sin síndrome navicular / Histochemical study of the distribution of collagen fibers on distal sesamoid bone in equine with and without navicular syndrome

La significancia funcional de cualquier relación que exista entre la orientación de las fibras de colágeno y la tensión ejercida sobre una estructura ósea dependerá de la influencia de estos parámetros microestructurales sobre las propiedades biomecánicas del hueso y su capacidad de adaptarse. Se estudió la localización del colágeno en el hueso sesamoídeo distal (HSD) de la mano en equinos con Síndrome Navicular para observar cómo este refleja las demandas biomecánicas ejercidas por la tensión que ejerce el tendón del músculo flexor digital profundo sobre la articulación interfalángica distal. Se utilizaron las tinciones hematoxilina-eosina-azul alcián, y Rojo Picrosirius de Junqueira. La birrefringencia de colágeno óseo fue determinada utilizando microscopía de luz polarizada. La remodelación del HSD resultó en la formación de osteonas secundarias transversales orientados en una dirección lateral a medial y el colágeno óseo se orientó de manera similar. Estos resultados proporcionan evidencia de la existencia de una relación entre la función mecánica de un hueso con su arquitectura, incluso demuestra que esta se extiende hasta el nivel molecular.

The functional significance of any relationship exists between the orientation of the collagen fibers and the strain on a bone structure depend on the influence of these microstructural parameters on the biomechanical properties of bone and its ability to adapt. Localization of collagen was studied in the distal sesamoid bone (DSB) in in equine foot with Navicular Syndrome to see how this reflects the biomechanical demands by the tension exerted by the tendon of the deep digital flexor muscle on the joint distal interphalangeal. Hematoxylin-eosin-alcian blue staining, and Red Picrosirius of Junqueira were used. The birefringence of bone collagen was determined using polarized light microscopy. The remodeling of DSB resulted in the formation of transverse secondary osteons oriented lateral to medial and bone collagen was oriented in similar direction. These results provide evidence for the existence of a relationship between the mechanical function of a bone with the architecture, and shows further that this extends up to the molecular level.

Morfometría, planimetría y estereología en el hueso sesamoídeo distal en manos de equinos con y sin síndrome navicular / Morphometry, planimetry and stereology in the distal sesamoid bone in equine foot with and without navicular syndrome

El Síndrome Navicular (SN) es una patología claudicógena bilateral crónica, degenerativa y progresiva, que compromete alhueso sesamoídeo distal (HSD), labolsa podotroclear, ligamentosy a las superficies adyacentes al tendón del músculo flexor digitalprofundo en manos de equinos. La hipótesis de que las características morfológicas del HSD en la mano de equinos varían en aquellos que presentan SN fue evaluada en este estudio. Para determinar cambios morfológicos en el HSD en manos de equinos con SN se realizó un estudio morfométrico, planimétrico y estereológico. Fueron evaluados dos grupos: No Afectadas (n=11) y Síndrome Navicular (n=11). Se evaluaron variables tales como peso, volumen, mediciones lineales, área y parámetros estereológicos tales como densidad de número (NA), volumen (VV) y superficie (SV). Los resultados obtenidos indican que a pesar de existir un proceso patológico e inflamatorio en la región del HSD que induce cambios mesoscópicos y microscópicos atribuibles a SN, no lograrían modificar sus características macroscópicas.

Navicular Syndrome (NS) is a chronic, degenerative and progressive bilateral claudication pathology, compromising the distal sesamoid bone (DSB), the podotrochlear bursa, ligaments and adjacent surfaces of the tendon of the deep digital flexor muscle of equine foot. The hypothesis that morphological characteristics of HSB in hand of horses vary in those with SN was evaluated in this study. A study was carried out to determine the morphological changes in the DSB in 22 left foot of horses with NS. We realized morphometrical, planimetrical and stereological studies in two groups of horses feet: Not Affected (n=11) and Navicular Syndrome (n=11). The following variables were quantified: weight, volume, linear measurements, area and stereological parameters: densities of number (NA), volume (VV) and surface (SV). Results indicate that although there is a pathological and inflammatory process in the region of DSB which induces mesoscopic and microscopic changes attributable to SN, their gross morphological features were not modified.

Differences in dynamic alignment and flexibility between junior high-school and high-school female basketball players / 体力科学

To identify athletes at a higher risk of anterior cruciate ligament (ACL) injury, we developed a video-based screening test focused on hip abductor and rearfoot function. However, age differences in hip or reafoot motion as a contributor to dynamic knee valgus remains unclear. The purpose of this study was to determine how age differences contribute to hip or reafoot motions. Eighty-three female basketball players (41 junior high-school and 42 high-school students) agreed to participate in this study. Participants were measured for hip rotation angle, tibial rotation angle, ankle dorsi-flexion angle, navicular drop and general joint laxity. Subjects also performed single-legged squatting and drop landing from a 30 cm box. Knee-in distance (KID) and Hip-out distance (HOD) were measured using 2-dimensional video images filmed at 30 Hz. Additionally, Dynamic Trendelenburg Test (DTT) and Heel-Floor Test (HFT) were performed. The prevalence of HFT-positive in junior high-school and high-school athletes were not statistically different. DTT-positive during landing was more prevalent in junior high-school athletes than in high-school athletes (P<0.05). Junior high-school athletes demonstrated greater HOD values in squatting than high-school athletes (P<0.05). The range of motion in high-school athletes was significantly greater than in junior high-school athletes in tibial external rotation, hip internal and external rotation (p<0.01). The navicular drop in junior high-school athletes was significantly greater than in high-school athletes (p<0.01), however the navicular height was greater in high-school athletes (p<0.01). Player's age is an important consideration in ACL injury preventative conditioning.