The Operative Reduction of Intra-articular Calcaneal Fractures.

In the past the evaluation of treatment modalities of calcaneal fractures has been fraught with the lack of well-designed, randomized clinical studies. As a result, surgeons treating these injuries were typically polarized when deciding between a surgical or nonsurgical approach to management. Among the many technical reasons for the frank dichotomy of treatment preferences were the difficulty in anatomical restoration, the relatively poor surgical access to the calcaneus, the limited internal fixation devices available for stabilization, and the difficulty in comprehensive radiographic imaging. Furthermore, the lack of complete understanding of the mechanism of sequential bony failure complicated the surgical exercise. The lack of standardized protocols for surgical treatment also lended to the controversy.

Trauma to the heel.

Anatomy and soft-tissue structure are reviewed as the basis for presenting descriptions of various types of trauma. Included are discussions of puncture wounds, tendon disruptions, fractures, degloving injuries, and fascial disruptions.

Pedal fusions in the rheumatoid patient.

This article reviews the indications for fusion in the rheumatoid arthritic patient. It also discusses the principles of arthrodesis in this group of patients and the unique considerations of the perioperative period. Technical considerations are presented relative to the decreased bone stock, bone grafting, and fixation. Finally, special technical procedures are discussed with respect to the more commonly performed arthrodesing operations.

Peroneus digiti minimi.

298 human cadaver feet were dissected to determine the incidence of occurrence and size of the peroneus digiti minimi. It was found to be present in 59.7% of the specimens and ranged in size from 0.5 mm to 2 mm. This was a much higher incidence of occurrence than had previously been documented. The significance of this finding is in question at the present time and needs further investigation.

The resistant, painful, plantar lesion: a surgical approach.

Osteotomies designed to lift the metatarsal head dorsally on the sagittal plane are performed to alleviate painful plantar lesions beneath the metatarsal head. Correcting the position of the bone reduces the plantar pressure and stresses that are believed to cause the painful lesions. The authors found that resistant plantar lesions secondary to a plantarly depressed or long lesser metatarsal responded to a combination of plantar excision and modified cartilaginous articulation preservation osteotomy procedure.

The deep band of the plantar aponeurosis of the human foot.

The deep band of the plantar aponeurosis is a variable structure formed by fibers from both the medial and lateral portions of the plantar aponeurosis. This band courses directly to the plantar ligament of the fourth metatarsophalangeal joint. Proximally it is superficial. Distally it passes deep to the tendons of the flexor digitorum longus to attach at the metatarsophalangeal joint. The second plantar and third and fourth dorsal interosseous muscles as well as the transverse head of adductor hallucis have attachments to the deep aponeurotic band. This band becomes taut when the proximal phalanx of the fourth toe is extended. No recent references to this structure could be found. The function of the deep band of the plantar aponeurosis is unknown, although the anatomical arrangement may make it important in stabilizing the fourth ray of the foot during locomotion.

The transverse head of adductor hallucis.

91 human cadaver feet were dissected to reveal the transverse head of adductor hallucis and measurements of the weights, angles of pull, width of origin and insertions were recorded. The origins and insertions of this muscle were found to differ from standard textbook descriptions. The origin usually includes the deep transverse metatarsal ligaments of the foot, the plantar ligaments of the lateral metatarsophalangeal joints, the intermuscular septa of the third and fourth muscle layers and the fibular syndesmosis of HENKEL (1913). The insertion was found to be usually by fleshy attachment to the lateral border of the oblique head of adductor hallucia. The angle of pull and the adjusted weights (% of intrinsic muscle mass) were found to be highly variable. In addition the transverse head was absent in 6% of the specimens. The function of this muscle is in question and it is likely that it is of little importance in normal foot functions.