Tibiotalocalcaneal arthrodesis in a rare case of tuberculosis of the talus.

Aim To assess our personal experience of a case of tuberculosis of the talus, and to provide an overview of the literature about the tuberculosis manifestations, including all its aspects: epidemiology, clinical and imaging presentation, and all the treatments available to the current state of knowledge. Methods We present our experience in a case of a 34-year-old patient, who came to our attention with difficulty in walking and pain due to a talar tuberculosis, with consequent bone disruption and reabsorption, and foot deformities. Results A tibiotalocalcaneal arthrodesis with retrograde nail and bone graft was performed after antibiotic therapy. Today, almost two years after the treatment, the patient can walk independently with no major limitations in everyday life. Conclusion Tibiotalocalcaneal arthrodesis with bone graft showed good functional results in this case study, with complete graft fusion and good functional and radiological outcomes.

Unveiling foot tuberculosis as an under-recognized source of foot pain.

PURPOSE: Foot tuberculosis is a rare form of osteoarticular tuberculosis, accounting for less than 1% of cases. It presents unique diagnostic challenges due to its nonspecific clinical features and overlapping symptoms with other conditions. This study aimed to investigate the clinical presentation, radiographic findings, and prognosis of foot tuberculosis, with the goal of improving early recognition and appropriate intervention. METHODS: A prospective study was conducted between November 2016 and July 2021, involving 39 patients diagnosed with foot tuberculosis. Clinical examinations, laboratory tests, X-rays, and MRI evaluations were performed to aid in the diagnosis. Biopsy was conducted on patients with radiological lesions. Patients were treated with an 18-month course of antitubercular therapy (ATT). Foot Function Index (FFI) scores were recorded before and after treatment. Statistical analysis was conducted to assess factors impacting prognosis. RESULTS: Unilateral foot involvement was observed in all patients, with a male predominance (61.5%) and a mean age of 31.3 years. The most common symptoms were pain and edema, with sinus tracts present in 17.9% of patients. Radiographic findings showed cystic and sclerotic lesions, with the "spina ventosa" appearance primarily affecting the metatarsal bones. MRI played a valuable role in early detection. Histopathological examination confirmed tuberculosis in all cases, and acid-fast bacilli were found in 23% of patients. Most patients (79.4%) responded well to ATT without requiring surgery. Factors such as high initial ESR, delayed ATT initiation, multiple lesions, and tarsal involvement were associated with unfavourable outcomes. CONCLUSION: Foot tuberculosis presents with nonspecific symptoms, leading to misdiagnosis and delays in appropriate treatment. Clinical examination, radiographic evaluation, and biopsy are essential for accurate diagnosis. Early initiation of ATT is crucial for favourable outcomes. Factors such as high initial ESR, delayed treatment initiation, multiple lesions, and tarsal involvement negatively impact prognosis. This study highlights the importance of recognizing foot tuberculosis and provides insights into its clinical presentation, radiographic features, and treatment outcomes, facilitating timely intervention and improved patient management.

Successful treatment of a painful os peroneum using conservative measures, infiltration therapy, and shock waves.

Lateroplantar foot pain may be caused by various entities, whereby painful os peroneum syndrome should be included in the differential diagnosis. Physical examination and multimodal imaging enable a definitive diagnosis. We report on a 59-year-old man with severe, load-dependent pain, corresponding to an os peroneum syndrome, triggered by a pes planovalgus with consecutively induced focal inflammation and tendovaginitis of the tendon of the peroneus longus muscle. Multifactorial conservative measures including infiltration and shockwave therapy finally led to a restoration of the original condition.

Os Intermetatarseum: A Rare Variation of Great Relevance / Os Intermetatarseum: Una Rara Variación de Gran Relevancia

SUMMARY: The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood.

El os intermetatarseum es un hueso accesorio ubicado en el pie, generalmente entre los 2 primeros metatarsianos y el hueso cuneiforme. Puede presentarse de forma libre, articulada o fusionada. Es una variación muy inusual que se encuentra en menos del 13 % de la población. Paciente de 27 años que acude a urgencias por lesión en tobillo. El examen físico mostró dolor y rango de movimiento limitado mientras soportaba una carga parcial. Las imágenes radiológicas mostraron un rastro óseo cerca de la base del primer y segundo metatarsianos, diagnosticado como os intermetatarseum. La formación de este hueso supernumerario comienza como un centro de osificación separado. La mayoría de los casos son asintomáticos; sin embargo, la compresión de las ramas profundas del nervio fibular en el espacio intermetatarsiano puede provocar dolor. Algunos autores sugieren que la presencia de este hueso puede provocar hallux valgus. El hueso intermetatarsiano puede llevar a confusión diagnóstica, principalmente relacionada con la fractura de Lisfranc. Su origen aún es poco comprendido.

How accurate is MRI for diagnosing tarsal coalitions? A retrospective diagnostic accuracy study.

OBJECTIVES: This study aimed to evaluate the diagnostic accuracy, inter-reader agreement, and associated pathologies on MR images of patients with confirmed TC. METHODS AND MATERIALS: In this retrospective study, 168 ankle MRI exams were included, consisting of 56 patients with clinically or surgically confirmed TC and 112 controls without TC, matched for age and sex. Images were analyzed independently by three radiologists blinded to clinical information. The evaluation criteria included the presence, type, and location of TC, as well as associated pathologies. After calculating diagnostic accuracy and the odds ratio of demographic data and anatomic coalition type for associated pathologies, inter-reader agreement was assessed using kappa statistics. RESULTS: The majority of TCs were non-osseous (91.1%) and located at the calcaneonavicular (33.9%) or talocalcaneal joint (66.1%). Associated pathologies included adjacent and distant bone marrow edema (57.1% and 25.0%), osteochondral defect of the talar dome (OCD, 19.6%), and joint effusion (10.7%) and accessory anterolateral talar facet (17.9%). Talar OCD was associated with increased patient age (p = 0.03). MRI exhibited a cumulative sensitivity and specificity of 95.8% and 94.3% with almost perfect inter-reader agreement (κ = 0.895). CONCLUSION: MRI is a reliable method for detecting tarsal coalition and identifying commonly associated pathologies. Therefore, we recommend the routine use of MRI in the diagnostic workup of patients with foot pain and suspected tarsal coalition. CLINICAL RELEVANCE STATEMENT: MRI is an accurate and reliable modality for diagnosing tarsal coalitions and detecting associated pathologies, while improving patient safety compared to computed tomography by avoiding radiation exposure. KEY POINTS: • Despite the technological progress in magnetic resonance imaging (MRI), computed tomography (CT) is still regarded as the gold standard for diagnosing tarsal coalition (TC). • MRI had a cumulative sensitivity of 95.8% and specificity of 94.3% for detecting tarsal coalition with an almost perfect inter-reader agreement. • MRI demonstrates high accuracy and reliability in diagnosing tarsal coalitions and is useful for identifying associated pathologies, while also improving patient safety by avoiding radiation exposure.

An Unusual Presentation of Giant Cell Tumour of Bone in the Talus: A Case Report and Literature Review.

Giant cell tumours (GCTs) of the bone often arise in the long bones while occurrence in smaller bones of the hand and feet is very rare. We report a case of GCT in the talus of a 17-year-old male who presented with a six-month history of worsening pain in his left ankle and loss of function, reducing his ability to walk and participate in sports. Radiographs of the ankle showed bony overgrowth on the head and neck of the talus with cortical breaching. MRI revealed possible extension into soft tissue and bone marrow oedema. CT scan also revealed an aggressive lytic lesion at the head and neck of the talus. He was managed with intralesional curettage and autologous bone grafting with bone harvested from the left knee. There was no evidence of recurrence at the six-month follow-up and the patient was able to walk freely. In conclusion, GCTs of the talus tend to occur in younger and healthier patients and have disastrous consequences if they persist, recur, or metastasize. Given the severe negative impact that GCTs have on a patient's quality of life, they must be ruled out when investigating any ankle pain or reduced mobility. Current treatment options have produced consistently positive results while novel therapies that enable a faster return to weight bearing and reduce recurrence appear promising.

MODIFIED MUBARAK TECHNIQUE FOR FLEXIBLE FLATFOOT CORRECTION IN CHILDREN AND ADOLESCENTS.

Objective: To describe the technique, analyze possible radiographic correction and evaluate the clinical result of medial and plantar calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy for flexible flatfoot correction. Methods: 23 patients (30 feet) diagnosed with flexible flat foot treated with plantar and medial calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy were evaluated retrospectively. In the lateral radiographs calcaneal pitch and Meary's angle were the radiographic parameters evaluated; while the talonavicular coverage angle was evaluated in the anteroposterior radiographs. To assess the clinical outcome of the surgical procedure, the American Orthopedic Foot and Ankle Society Score (AOFAS) for the ankle and hindfoot was adopted. Results: The mean values of the evaluated angles and AOFAS score for ankle and hindfoot significantly improved when comparing pre- and postoperative values. Conclusion: Plantar and medial calcaneal displacement osteotomy associated with an opening wedge cuboid osteotomy is able to improve radiological and clinical parameters of child patients with flexible flatfoot. Level of Evidence III, Retrospective Comparative Study.

Objetivo: Descrever a técnica, analisar possíveis correções radiográficas e avaliar o resultado clínico da osteotomia de deslocamento medial e plantar do calcâneo associada à osteotomia em cunha de adição do cuboide para correção do pé plano flexível de crianças. Métodos: Foram avaliados retrospectivamente 23 pacientes (30 pés) com diagnóstico de pé plano flexível tratadas com osteotomia de deslocamento plantar e medial do calcâneo associada à osteotomia em cunha de adição do cuboide. Os parâmetros radiográficos avaliados nas imagens em perfil foram o pitch do calcâneo e o ângulo de Meary, enquanto nas radiografias anteroposteriores o ângulo de cobertura do tálus. Para avaliar o resultado clínico do procedimento cirúrgico, foi adotado o escore da American Orthopaedic Foot and Ankle Society (AOFAS) para tornozelo e retropé. Resultados: Os valores médios dos ângulos avaliados e do escore AOFAS para tornozelo e retropé melhoraram significativamente na comparação dos resultados pré e pós-operatórios. Conclusão: A osteotomia de deslocamento plantar e medial do calcâneo associada à osteotomia em cunha de adição do cuboide é capaz de melhorar os parâmetros radiológicos e clínicos de crianças com pé plano flexível. Nível de Evidência III, Estudo Comparativo Restrospectivo.

Müller-Weiss disease: a functional and quality of life assessment.

PURPOSE: Evaluate the functional health status and quality of life of patients diagnosed with Müller-Weiss disease and, secondarily, determine the influence of factors such as gender, social status, race, body mass index, and surgical and non-surgical treatment in patient outcome. METHODS: This study included 30 affected feet (18 patients) with follow-up from 2002 to 2016. Five patients were excluded from reassessment, resulting in 20 feet (13 patients). Questionnaires for functional and quality of life assessments were administered, and statistical analysis was performed. RESULTS: Patients with obesity had poor functional results and low quality of life rates. Regarding quality of life, mainly in the mental health domain, there was a significant difference (p < 0.001) that was not observed in other domains investigated, except for surgical treatment, which was superior to non-surgical treatment in terms of the physical domain (p = 0.024). Bilateral treatment was also superior to unilateral treatment in Coughlin's classification (71.4% versus 66.7%). CONCLUSIONS: Müller-Weiss disease evolved with poor functional results and low quality of life rates in patients with obesity, with no method of treatment influence on patient outcome, except for the SF-12 physical domain, where surgical treatment showed better results than conservative treatment.

[Fractures of the talar neck and body : An overview]. / Frakturen des Talushalses und -Corpus : Eine Übersicht.

Fractures to the talar neck and talar body (central talar fractures) are rare injuries but often result in devastating outcomes. It is therefore important to diagnose these injuries early and provide the best possible treatment. The analysis, classification, and surgical planning of central talar fractures should be based on computed tomography (CT) imaging. In the case of dislocated fractures, surgeons must strive for an anatomic reduction and fixation. The approach routes are based on the fracture morphology and must enable adequate reduction of the fracture. This can often only be achieved by two or more approach routes. The outcome correlates with fracture complexity and the quality of the reduction. Complications such as avascular necrosis and posttraumatic osteoarthritis are common and have a negative effect on the results of the treatment.

Dorsal Dislocation of Intermediate Cuneiform With Multiple Cuneiform and Cuboid Fractures Combined With Lisfranc Injury: A Case Report.

Multiple cuneiform fractures combined with isolated intermediate cuneiform dorsal dislocation and cuboid fracture, with disruption of the Lisfranc ligament, are rare injuries. In this study, we present a polytrauma patient who sustained these injuries, his treatment course, and the follow-up period. The patient was operated on the day of the injury and six months after that the results are very satisfactory.

Modified mubarak technique for flexible flatfoot correction in children and adolescents / Técnica de mubarak modificado para correção do pé plano flexível de crianças e adolescentes

ABSTRACT Objective: To describe the technique, analyze possible radiographic correction and evaluate the clinical result of medial and plantar calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy for flexible flatfoot correction. Methods: 23 patients (30 feet) diagnosed with flexible flat foot treated with plantar and medial calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy were evaluated retrospectively. In the lateral radiographs calcaneal pitch and Meary's angle were the radiographic parameters evaluated; while the talonavicular coverage angle was evaluated in the anteroposterior radiographs. To assess the clinical outcome of the surgical procedure, the American Orthopedic Foot and Ankle Society Score (AOFAS) for the ankle and hindfoot was adopted. Results: The mean values of the evaluated angles and AOFAS score for ankle and hindfoot significantly improved when comparing pre- and postoperative values. Conclusion: Plantar and medial calcaneal displacement osteotomy associated with an opening wedge cuboid osteotomy is able to improve radiological and clinical parameters of child patients with flexible flatfoot. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Descrever a técnica, analisar possíveis correções radiográficas e avaliar o resultado clínico da osteotomia de deslocamento medial e plantar do calcâneo associada à osteotomia em cunha de adição do cuboide para correção do pé plano flexível de crianças. Métodos: Foram avaliados retrospectivamente 23 pacientes (30 pés) com diagnóstico de pé plano flexível tratadas com osteotomia de deslocamento plantar e medial do calcâneo associada à osteotomia em cunha de adição do cuboide. Os parâmetros radiográficos avaliados nas imagens em perfil foram o pitch do calcâneo e o ângulo de Meary, enquanto nas radiografias anteroposteriores o ângulo de cobertura do tálus. Para avaliar o resultado clínico do procedimento cirúrgico, foi adotado o escore da American Orthopaedic Foot and Ankle Society (AOFAS) para tornozelo e retropé. Resultados: Os valores médios dos ângulos avaliados e do escore AOFAS para tornozelo e retropé melhoraram significativamente na comparação dos resultados pré e pós-operatórios. Conclusão: A osteotomia de deslocamento plantar e medial do calcâneo associada à osteotomia em cunha de adição do cuboide é capaz de melhorar os parâmetros radiológicos e clínicos de crianças com pé plano flexível. Nível de Evidência III, Estudo Comparativo Restrospectivo.

Eficiencia de la técnica de Broström-Gould en el tratamiento quirúrgico de la inestabilidad lateral crónica de tobillo / Broström-Gould technique efficiency in chronic lateral ankle instability surgical treatment

Los déficits neuromusculares resultantes de las lesiones que comprometen al tobillo, facilitan la aparición de recidivas, por la afectación estructural que no sólo ocurre en los ligamentos, sino también en los nervios y tejido músculo-tendinoso, pudiendo provocar numerosas alteraciones asociadas que provocan inestabilidad crónica. El objetivo de este trabajo es analizar la eficiencia de la técnica de Broström modificada en pacientes con inestabilidad crónica del tobillo, atendidos en el Hospital Dr. Miguel Pérez Carreño y consulta privada entre noviembre 2016 y enero 2020. El tipo de investigación prospectiva, descriptiva, de campo clínico. La muestra la conformaron 31 pacientes. La edad promedio fue 34,4 años, la mayoría de género masculino, y con predominio en el tobillo derecho. Al aplicar la escala EVA en el pre y post quirúrgico, se observó disminución del grado de dolor postquirúrgico con una escala entre 0 y 4. La escala de Karlsson y Peterson aplicada en el lapso de 1 año después del período postquirúrgico a los pacientes, el 90 % estuvo entre 65 y 90 según escala que significa bueno y excelente. Entre la escala EVA y la de Karlsson y Peterson aplicados al año, se observó una relación entre la disminución del dolor y la buena y excelente evaluación funcional. La técnica de Broström modificada demostró tener muy buenos resultados en el tratamiento quirúrgico de la inestabilidad de tobillo(AU)

The neuromuscular deficits resulting from ankle injuries, make possible the appearance of recurrences, due the structural affectation that not only occurs in the ligaments, but also in nerves and muscle-tendon tissue, and can produce numerous associated alterations that cause ankle chronic instability. The objective is to analyze the efficiency of Broström modified technique in patients with chronic ankle instability, treated at the Dr. Miguel Pérez Carreño Hospital and private practice from November 2016 to January 2020. A prospective, descriptive and clinical study was made. 31 patients were included. The average age was 34,4 years, majority of male patients, and predominance of right ankle. When applying the VAS scale before and after surgery, a decrease in the degree of postoperative pain was observed with a scale between 0 and 4. The Karlsson and Peterson scale applied in the period of 1 year after the postoperative period to the patients, the 90% were between 65 and 90 according to a scale that means good and excellent. Between the VAS scale and the Karlsson and Peterson scale applied after one year, a relationship was observed between pain reduction and good and excellent functional evaluation. The modified Broström technique has shown to have very good results in the surgical treatment of ankle instability(AU)

SUBTALAR JOINT IN NEUTRAL AND RELAXED POSITIONS FOR EVALUATION OF MEDIAL LONGITUDINAL ARCH.

OBJECTIVE: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. METHODS: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson's test. RESULTS: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). CONCLUSION: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

OBJETIVO: O arco longitudinal medial é a estrutura principal para suporte de carga e absorção de impacto no pé. Medidas para avaliação do arco longitudinal medial, como a altura navicular, o ângulo do arco longitudinal medial e a linha de Feiss devem ser realizadas com a articulação subtalar na posição neutra e relaxada. Este estudo analisou a correlação entre as medidas da articulação subtalar em posições neutra e relaxada durante os testes de avaliação do arco longitudinal medial. MÉTODOS: Neste estudo transversal, 51 voluntários saudáveis (102 pés; 36 mulheres; 28 ± 5 anos, 1,66 ± 0,10 m; 24,5 ± 4,5 kg/m2) tiveram altura navicular, ângulo do arco longitudinal medial e linha de Feiss medida nas posições neutra e relaxada. A correlação entre eles foi avaliada pelo teste de Pearson. RESULTADOS: Houve uma correlação muito forte das medidas de linha de Feiss de 102 pés entre a posição neutra e relaxada (r = 0,81) e uma correlação moderada entre o ângulo do arco longitudinal medial (r = 0,78) e altura navicular nas posições neutra e relaxada (r = 0,76). CONCLUSÃO: As medidas do arco medial longitudinal entre as posições neutra e relaxada estão fortemente correlacionadas. Não é necessário, portanto, medir o arco longitudinal medial nas posições neutra e relaxada. Nível de Evidência II, Estudos diagnósticos - Investigação de um exame para diagnóstico.

Subtalar joint in neutral and relaxed positions for evaluation of medial longitudinal arch / Articulação subtalar em posições neutra e relaxada para avaliação do arco longitudinal medial

ABSTRACT Objective: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. Methods: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson's test. Results: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). Conclusion: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

RESUMO Objetivo: O arco longitudinal medial é a estrutura principal para suporte de carga e absorção de impacto no pé. Medidas para avaliação do arco longitudinal medial, como a altura navicular, o ângulo do arco longitudinal medial e a linha de Feiss devem ser realizadas com a articulação subtalar na posição neutra e relaxada. Este estudo analisou a correlação entre as medidas da articulação subtalar em posições neutra e relaxada durante os testes de avaliação do arco longitudinal medial. Métodos: Neste estudo transversal, 51 voluntários saudáveis (102 pés; 36 mulheres; 28 ± 5 anos, 1,66 ± 0,10 m; 24,5 ± 4,5 kg/m2) tiveram altura navicular, ângulo do arco longitudinal medial e linha de Feiss medida nas posições neutra e relaxada. A correlação entre eles foi avaliada pelo teste de Pearson. Resultados: Houve uma correlação muito forte das medidas de linha de Feiss de 102 pés entre a posição neutra e relaxada (r = 0,81) e uma correlação moderada entre o ângulo do arco longitudinal medial (r = 0,78) e altura navicular nas posições neutra e relaxada (r = 0,76). Conclusão: As medidas do arco medial longitudinal entre as posições neutra e relaxada estão fortemente correlacionadas. Não é necessário, portanto, medir o arco longitudinal medial nas posições neutra e relaxada. Nível de Evidência II, Estudos diagnósticos - Investigação de um exame para diagnóstico.

Radiological tarsal bone morphology in adolescent age of congenital clubfeet treated with the Ponseti method.

BACKGROUND: Major abnormalities of tarsal bone shape after surgical clubfoot treatment are well known from the literature. The Ponseti method has gained widespread acceptance in primary treatment of congenital clubfeet. Despite the longtime experience, data regarding the development of tarsal bones after this treatment are still rare. The aim of the study was therefore to evaluate radiographic parameters describing tarsal bone shape of clubfeet after Ponseti treatment and compare them to age-matched healthy feet. METHODS: Twenty two consecutive severe clubfeet in 14 patients were investigated by repeated diagnostic ultrasound during the corrective process. Extent and temporal course of correction were documented with standardized X-rays after a mean follow-up of 12 years (between the ages of 10-14 years) and compared to a group of age-matched normal feet. RESULTS: Reliability testing for all X-ray parameters showed good to excellent results. In comparison to the control group, all parameters except the radius of the trochlea (RT) were significantly altered in clubfeet with highest differences shown for the anterior talar motion segment (ATM), talonavicular coverage (TNC) and the talometatarsal index (TMT-Index). Differentiation between minor and major deformities showed significant differences only for the front tarsal index (FTI). CONCLUSIONS: Tarsal bone shape of clubfeet treated by the Ponseti method differs significantly from normal feet. One of the most pronounced and clinically relevant difference of the clubfoot talus compared to the normal talus is the markedly reduced anterior talar motion segment.

[Minimally invasive components of the treatment of tibialis posterior insufficiency in adults : Tendoscopy of the Achilles tendon, minimally invasive calcaneus displacement osteotomy and the sinus tarsi spacer]. / Minimal-invasive Komponenten der Therapie der Tibialis-posterior-Insuffizienz des Erwachsenen : Tendoskopie der Achillessehne, minimal-invasive Kalkaneusverschiebeosteotomie und Sinus-tarsi-Spacer.

Minimally invasive medializing calcaneal osteotomy, the implantation of a tarsi spacer and the tendoscopy of the posterior tibial tendon have been established as treatment options for tibialis posterior insufficiency grade II. The minimally invasive medializing calcaneal osteotomy allows a correction of the hindfoot valgus like an open procedure with a significantly lower risk of wound healing problems. It has gained increasing popularity within recent years. There is also good evidence for arthroereisis, with the use of the sinus tarsi spacer being primarily an addition to calcaneus sliding osteotomy. The possibilities for tendoscopy of the posterior tibial tendon are limited to debridement and synovectomy. Various papers report minimally invasive alternatives to the strayer procedure for a shortened gastrocnemius muscle. The proximal lengthening of the medial head of the gastrocnemius muscle is particularly popular as a soft tissue-sparing, less traumatic procedure. So far, no reports of a minimally invasive cotton osteotomy have been found in the literature.

The Carpal and Tarsal Bones of the Human Body: Arabic mnemonics.

Memorising human anatomy structures remains a challenge for nursing students. Educators endeavour to make human anatomy interesting and easy to memorise. Various instructional approaches can be used to help students enhance their memory. Mnemonics, for example, are well-established educational strategies that have proven useful in the encoding, retention and retrieval of anatomical terms. The carpal and tarsal bones are some of the anatomical structures that prove challenging to nursing students' study of anatomy. Although available online to students, most of the accessible mnemonics are in English and non-native English-speaking students (students who are native Arabic-speakers) might find them difficult to understand. Therefore, we have created two simple Arabic mnemonics that can simplify the memorisation of the carpal and tarsal bones. We believe that Arabic mnemonics effectively enhance memorisation by linking the new learning material to familiar information.

Effect of Achilles tendon on kinematic coupling relationship between tarsal bones: a pilot finite element study.

BACKGROUND: The procedure of percutaneous Achilles tenotomy (PAT) is an important component of the Ponseti method. However, few studies reported the influence of Achilles tendon on kinematic coupling relationship between tarsal bones. The purpose of present study was to demonstrate the effect of Achilles tendon on the kinematic coupling relationship between tarsal bones, and to illustrate how kinematic coupling relationship between tarsal bones works in term of finite element analysis. METHODS: A three-dimensional finite element model of foot and ankle was constructed based on the Chinese digital human girl No.1 (CDH-G1) image database using the software of mimics, Geomagic studio, HyperMesh, and Abaqus. The last manipulation of the Ponseti method before the procedure of PAT was simulated. The talus head and the proximal tibia and fibula bone were fixed in all six degrees of freedom, and the outward pressure was added on the first metatarsal head to investigate the kinematic coupling relationship between tarsal bones. RESULTS: The least relationship of kinematic coupling between tarsal bones was found in calcaneus. Stress concentration was mainly observed at the navicular, talus and the medial malleolus. The difference in displacement of the navicular was only found with the Achilles tendon stiffness of 0 N/mm and others. No difference in the navicular displacement was found in the stiffness of Achilles tendon between 40, 80, 200, 400, and 1000 N/mm. The maximum displacement of navicular was observed at the ankle position of PF-20° (plantar flexion-20°). The difference in displacement of the navicular was greater at the ankle position of PF-20° with the Achilles tendon stiffness of 0 N/mm than that at the ankle position of PF-40° with the Achilles tendon stiffness of 40 N/mm. CONCLUSIONS: Based on the findings from this study, it was demonstrated that the Achilles tendon existence or not and ankle position had great influence, while increased stiffness of Achilles tendon had no influence on kinematic coupling relationship between tarsal bones. For the cases with severe equinus, earlier implementation of PAT procedure (with the purpose of release the Achilles tendon and reduce the degree of ankle plantar flexion) may be beneficial to the deformity correction.

Epidemiology of injuries due to ankle sprain diagnosed in an orthopedic emergency room / Epidemiologia das lesões por entorse do tornozelo diagnosticadas em pronto atendimento de ortopedia

ABSTRACT Objective To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. Methods We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. Results Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. Conclusion There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.

RESUMO Objetivo Avaliar na ressonância magnética a prevalência das diferentes lesões ligamentares do tornozelo e do pé, bem como de fraturas não diagnosticáveis radiograficamente, em pacientes com queixa de entorse do tornozelo. Métodos Foram incluídos no estudo 180 pacientes consecutivos, com história de entorse do tornozelo, atendidos em um serviço de Atenção Primária no período de 12 meses. Os achados dos exames de ressonância magnética foram catalogados e descritos. Resultados Aproximadamente 92% dos pacientes apresentaram algum tipo de lesão na ressonância. Dentre as injúrias observadas, estavam 379 lesões ligamentares, 9 lesões osteocondrais, 19 lesões tendíneas e 51 fraturas. Apenas 14 ressonâncias magnéticas (7,8%) não mostraram qualquer tipo de lesão. Observamos relação positiva entre lesões do complexo lateral, sindesmose e medial. No entanto, houve correlação negativa entre lesões ligamentares do tornozelo e aquelas do mediopé. Conclusão Foi alta a ocorrência de lesões secundárias à entorse. Apontamos correlação entre as lesões ligamentares laterais com as sindesmodais e do deltoide. Não notamos relação entre as lesões do deltoide e da sindesmose, e nem entre as ligamentares laterais e a subtlalar. Também não foram observadas relações entre as lesões do tornozelo e as do mediopé.

Tarsal Navicular Fracture in a Parkour Practitioner, a Rare Injury - Case Report and Literature Review.

Tarsal navicular fractures, as well as other midfoot injuries, are rare, and can result in severe impairment if not properly treated. Parkour, a modern sport, is gaining popularity among young individuals in urban areas, and is prone to result in high-energy trauma, which is scarcely described in the literature. The following is a report of a rare case of tarsal navicular fracture in a 17-year-old male, sustained during parkour practice, which was treated successfully with open reduction and internal fixation. The description of the case emphasizes the challenges of its approach; the discussion highlights the treatment options and goals. The case should also raise awareness about the increasing occurrence of these uncommon lesions.